Accepting Insurance

[Salerio]

I have begun the process of becoming a provider of massage for subscribers of insurance companies. A credentialling company represents a number of insurers, and once I am approved, they will list me on their website and refer callers to me.

I am supposed to offer a discount, anywhere between 10%-25% off my regular fees, no paper work, referrals, etc. The client just pays me.

My question is this - why couldn't I just accept anyone who calls who asks if I take insurance, and say yes, even if this credentially company does not list that particular insurance company? I would just give them the discount.

I don't know if this is "appropriate," but I can't see an immediate problem with doing it.

What do you think?

 

[Pompal 09.]

So until I am "credentialled," what I would say to a person asking if I take insurance ... "no, however I would be happy to offer the same discount as you would receive if I 'took insurance.'" After being credentialled, I would just say yes, regardless of who they had for insurance, correct?

I don't want to infer that I do something that I don't. I understand your meaning of marketing - I never thought of it that way. But somehow I felt that if someone had to "approve" me by checking my qualifications out, there was more to it than that.

 

[Like legitly legit]

So until I am "credentialled," what I would say to a person asking if I take insurance ... "no, however I would be happy to offer the same discount as you would receive if I 'took insurance.'" After being credentialled, I would just say yes, regardless of who they had for insurance, correct?

It sounds to me that even after you are credentialled that you won't be 'accepting insurance' but offering a 'discount to those with insurance.' There's a significant difference here -- if you were accepting insurance you would be submitting forms to, let's say Blue Cross MA, for your client's massage and they would have a small co-pay. You'll wait weeks before receiving payment from your client's insurance company. That is of course, if their insurance will cover your services (massage I presume).

In the second case you are just offering your clients a discount off your regular rates because they carry an insurance card. All you would be doing then is verifying that they do indeed have a card, with the insurance companies you offer discounts for (Blue Cross, Harvard Pilgrim, or whatever), and they get a set discount that has been agreed upon by you and the insurance company or the third party credentialling company.

Hope this helps.

 

[Pyewacket]

From my understanding through another MT in my area (who gave me all this information in the first place), there is no co-pay, no forms to submit, no referrals needed, and no paper work to be submitted. This is the reason for "credentialling."

After the approval, I will be listed under many insurance companies as a provider (since the insurance companies pick their own credentialling company and many use the same one).

Other insurance companies, like Tufts who use a different credentialling company, require a cumbersome procedure to become "credentialled," and if they ever return my call and send me the paper work, I may or may not agree to do it.

So after being credentialled, it SEEMS that (and I'll find out more soon), once the client comes in, they are given the discount, pay me directly and no paper work or waiting to be reimbursed.

Maybe enough people complained about the procedures and the insurance companies listened ... less work for them as well.

 

[tvcclan1]

silence -

Regardless if it is marketing hype, it's what's required to get in their directory. (Have you had a negative experience with the insurance companies?) I do understand what you are saying, but I'm concerned with legalities and being honest. And it certainly is my option to do it or not do it. I am in the exploring phase right now.

It seems the general public has been lead to believe that they cannot have a discounted massage through "insurance" unless we (mts) are listed with them. If I say I am not a provider but will be happy to discount their massage as if I were, they may still back away, thinking I'm not "screened" and approved by their insurance company.

There is a comfort when being referred - to anyone, for massage, plumbing, restaurant, etc. I think the client may hesitate to come to an mt if their insurance company did not refer them, even if I still offer the same discount.

Next time I am asked by a potential client, I will try it out and see what happens.

 

[Dewi]

Is alternative care covered?
Most Blue Shield plans provide chiropractic coverage. The Active Start Plan 35 also covers acupuncture. You can also save money through the mylifepath alternative health services discount program, a standard feature on all Blue Shield plans, on the following services by receiving discounts of at least 25% off the provider's usual charge or the program's maximum fee schedule:
Acupuncture
Chiropractic
Massage therapy

Please note that none of the terms and conditions of Blue Shield's health plans applies to these discount services as these discounts are not part of your health plan covered services.

Alternative Health Care Programs from Aetna, Vision One® and Fitness and similar discount programs are rate-access programs and may be in addition to any plan benefits. Discount and other similar health programs offered hereunder are not insurance and program features are not guaranteed under the plan contract and may be discontinued at any time. Program providers are solely responsible for the products and services provided hereunder. Aetna does not endorse any vendor, product or service associated with these programs. It is not necessary to be a member of an Aetna plan to access the program participating providers.

 

[thejanith]

Accepting Insurance

These programs where MTs sign up and are "credentialed" and then give discounts are called Affinity programs. They are the hallmark of managed care. In California there are several companies like Blue Cross, Health Net, ACN, and AHSN that want providers to give 20-30% off regular rates. I think these programs may only work for someone who has openings in their book, has resources to stay afloat, and has patience to deal with all the "discount seekers" who are looking for a WalMart massage experience.
In the real medical-insurance world providers under these plans-MDs, DCs, etc. who can see a large number of patients at 10 minute intervals -take on these plans to get a volume of patients at a certain fee. The insurance company sets the fees, etc.
There is no way an MT can duplicate this kind of schedule. This is what it takes to stay profitable. This also suppresses the price of the service. And what do you tell your other clients who don't/can't get the discount?

There is one hospital in my area, they don't negoiate with insurance. Their fees are 30% than most insurance companies pay. A lawyer is now trying to file a class action suit against them for overcharging uninsured patients. This is happening in other states-hopefully a trend.

My point is that these "insurance plans" suck. They are not fair and will not support anyone's business. They save big $ by letting clients get cheap treatment that will improve their long term health, at no cost to the company.

Just my $ 0.02.

Rubmyster

I don't recommend these plans no matter what BS the company tells you about being credentialed.

 

[doradoe]

Thanks for everyone's input. My head is spinning now :roll:

 

[Cat Litter Man]

This is the first I've heard of these programs, but I am not even interested in insurance or finding clients who want insurance to pay for massage.

If these are the clients you want to go after then go for it, or just learn how to take insurance.

Or you can do your own marketing and offer some sort of discount to certain types of clients. Let's say you create a discount program for the paralegals of certain law firms that are interested in offering this type of "reward" or perk to their employees. I think doing something like the "give to get" marketing program might be interesting to try for that.

I recently donated 65 "gift certificates" for National Educators Week. The schools gave them to the employees. I made them look like the school "bought" them by wording it "A Gift For You..." that way it still seems like a referral instead of a discount from me. They were given out last week and I have already gotten a few calls.

I did that to get new people in for a massage and then to introduce them to my maintenance plan (which is my "discount" for regulars).