Insurance and discounting

[cosmictouch]

Does anyone on the board know if accepting insurance will limit me on discounts I can offer to clients? I cross-refer with a Chiro and he is always talking about how he can't offer discounts or free assessments because he accepts insurance. Is this something MTs are subject to also if they contract with an insurance company? Does it differ with each insurance carrier?

Thanks for any light anyone can shed on this.

Angela
Texas

[squash_blsm]

I don't deal with insurance but chiro's around here offer free assessments all the time to promote business.
Not sure what his point is...

Anyway - if you are submitting to insurance then usually you are only going to get what the company reimburses you as full payment for the session. You can't discount that because the client isn't even paying you. And reimbursement varies between carriers so you often don't even know what you will get until you get the check.
unless of course you are only seeing WC and PI cases.

So - anyway - for your NON-insurance clients you can offer whatever discount you want.

[MelissaWellx]

Hi Angela,

I work for a company called Wellx.com, which offers scheduling/billing software that will soon do insurance billing for MTs. I have spoken to everyone in my office, including the licensed insurance agent, and we have never heard of a policy that precludes anyone from offering a discount (even Chiros). However, If you give me a day I'll contact an expert and get back to you.

In the meantime, can you clarify if your chiro means he cannot give discounts to people who are paying with insurance, or cannot give discounts at all?

Regards,

Melissa

[cosmictouch]

I am thinking maybe the Chiro doesn't understand how that all works. Whenever we talk about marketing, he hems and haws about how his hands are tied by the insurance company in giving new patient incentives/free assessments/etc. that I see other Chiros doing all the time. I find it hard to believe that NONE of the other area Chiros don't take insurance since it is more commonly covered than massage.

Melissa, I'd love to get more information from you. Please post it here, if allowed, so everyone can benefit.

Angela

[MelissaWellx]

Ok, I just heard back from my expert, and I'm just going to copy and paste his reply:

You can offer discounts with cash paying customers no matter what. However, if you have an insurance patient and bill insurance by law you cannot discount the service, you are required in some states to collect the Co-Payment. But, you are not required to bill the patient for the balance due if you do not wish to do so; you can but because of hard times many will not pay and stop coming for treatment. So, in a way they are getting a discount, if you don't bill for the remainder of the balance. Very few insurance companies pay 100% of what you bill. The typical is 80% of what you bill will be paid by the insurance company (minus the co-pay at the time of service).

Are you filing via paper or via electronic filing?

Cash patients you don't have to do soap notes on if you don't want to. Insurance patients you have to, otherwise if something happens to the patient and sues you need to have documented proof of what happened each session. You will also from time to time get your records subpoenaed so be prepared. If you complete the 1500 form, copy the prescription and complete the soap note for each session and put it in your charts then you're covered.

I have been called to testify 2 times now as an expert witness. You will be given a copy of your soap notes to re-read to refresh your memory then asked questions about what happened. Usually, you will be called to court when the patient is suing the insurance company for refusing to pay for bills. This happens primarily with workers compensation and Auto accidents or PIP cases.

Insurance companies won't let massage therapists in some states be in network. So you can't contract with them; they won't let you. If they send you a contract they don't think you're an LMT.

The chiro CAN offer free assessments. Insurance companies have nothing to say about that, unless he is trying to bill the insurance company for the assessment and not collecting a co-pay. Then no, he can't do that. You can do the same. Offer a free assessment for treatment without charging. You just can't charge the insurance company for the assessment, and cannot collect a co-pay.



So that's the indepth-answer. Does that cover it? If not, tell me what else you need to know, and I'll work on it.

Melissa