How to compete with Chiros who bill insurance for massage

[trustluvlove]

I have worked for 6 years in chiropractic offices for an hourly wage. It is a safety net, but they do have a tendency to over book. I have recently decided to branch out and I am now working in a small but gorgeous spa Th F Sa every week with a great team (I am the only LMT in the spa) and a selfless owner. I still work M Tu W for a chiro to pay the bills. I have a few regulars at the spa, but I feel like I am competing against myself. I have had so many clients come into the spa wanting me to bill insurance. I have no desire to do that. I have been witness to far too many headaches and uncomfortable moments with insurance issues working in the clinics to even think about taking on that extra responsibility. So I have had several clients at the spa who stop coming once they find someone to bill insurance for their massage sessions. I am also declining more hours at the clinic to pursue this other avenue. Part of me thinks I'm insane to turn down guaranteed money to set in a spa and hope someone wants a massage. I'm actually doing more than that. I offer monthly specials, use my chair to participate in local events to meet people and educate them about chronic pain patterns and the benefits of medical massage. Some times it all seems like a waste of time, but I love being an LMT and I want to continue to learn about the craft and have longevity in this field. So I would really like to hear some success stories of how some of you have broken away for the chiro curse and some rebuttals and explanations on the pros and cons of paying for massage "out of pocket" verses having it covered by your insurance by a DC.

 

[Fashionislove]

How to compete with Chiros who bill insurance for massage

So I would really like to hear some success stories of how some of you have broken away for the chiro curse and some rebuttals and explanations on the pros and cons of paying for massage "out of pocket" verses having it covered by your insurance by a DC.

I simply tell people I don't bill insurance. I am small practice and don't have the time to do the paperwork, follow up on that paperwork and maintain my practice. If they don't like that, I suggest they try to find a place that offers what they are looking for.

 

[Bag Full Of Questions]

How to compete with Chiros who bill insurance for massage

I don't take insurance either and am very busy. If you are helping your clients feel better, then they will still keep coming to you.

 

[sgrag3003]

How to compete with Chiros who bill insurance for massage

So I would really like to hear some success stories of how some of you have broken away for the chiro curse and some rebuttals and explanations on the pros and cons of paying for massage "out of pocket" verses having it covered by your insurance by a DC.

In answer to the question posed above, I don't think you're going to be able to convince a prospective client whose insurance will cover their massage if they go to another MT (who's willing to bill their insurance company) to go to you instead (and therefore have to pay out of pocket) UNLESS this client is someone who already knows (and loves) your work AND is willing to either eat the cost or submit their receipt for reimbursement.

You mention that you are expending much effort doing outreach and education to people regarding the benefits of medical massage but you end up losing these clients because you don't bill insurance. IMO, if you are turning away so many clients due to not wanting to bill insurance you have two options: either rethink your target market (chronic pain clients) OR bite the bullet and bill insurance.

A significant portion of my practice is medical massage - not only chronic pain but acute injury clients also. I would estimate that approximately 1/2 of my annual revenues come these cases. Is it extra work? Yes. Can it be a pain? Yes, but after awhile - once you become more familiar with how insurance companies work and how to navigate the system - it becomes much easier and much less of a pain. And yes, there are types of insurance I will not bill (worker's comp for instance) and insurance companies I will not bill (companies whose policies and practices are particularly "painful" to deal with.)

FWIW, while I have worked WITH chiropractors during my career, I have never worked FOR one and I don't feel I have ever been in competition with them. There are a lot of chiropractors who don't want to have MTs working FOR them but are eager to refer to us so we can help their patients. A busy chiropractor who refers patients to you can keep you quite busy...As other people have pointed out, you can become very busy without doctor referrals and without accepting insurance, but if your ideal client is someone who has physical issues that are covered by their insurance, it's going to be very difficult for you to develop that clientele without being willing to submit bills to their insurance carrier.

Even if you ultimately decide to continue not accepting insurance, you still might want to look into taking a class on insurance billing. It never hurts to become more familiar with how that process works even if you don't want to be part of it.

 

[Pompal 09.]

How to compete with Chiros who bill insurance for massage

Most of the so called "Medical Massage Therapists" who work for chiros in my area usually only give Swedish massage with more pressure. I have worked with LMTs who don't understand what myofascia is, (myofascia was barely covered in massage school and I went to one of the better schools in my area, 1000 hours, I learned about myofasica release from Sean Riehl, Art Riggs ceus/seminars and massage articles) or do they understand the precautions you need to take when working on clients who have had mastectomies or any other type of lymph nodes extraction. Even the good ones dont understand the concept of proprioceptive muscle memory. I have learned this from speaking to them and their clients. So I know that they are not getting the same quality of work that they would be if they paid out of pocket for my sessions. I dont mean to sound arrogant, but I have never met an MT or LMT in my area who reads medical articles daily, takes medical massage ceus, or even know or participate on this forum like I do. The LMTs in this area usually only make $12-$15 an hour and dont have the funds for ceus, some even go so far as to let their license expire because of it. But continue working illegally. I make slightly higher than that, because I am lucky enough to work for someone who values true medical massage. But I am over booked quite often (10-17 twenty-five minute sessions a day/3.5 days a week) and I have to increase my own client base in order to continue this line of work indefinitely. I just need to figure out a way to educate my potential clientele without sounding arrogant or like I am bashing other LMTs.

 

[AAAHHHHH]

How to compete with Chiros who bill insurance for massage

I have never had a spa client ask about insurance billing.
In addition, IMO, clients who are only willing to care for their own health based on what their insurance will pay for are not good clients.
And in my experience - accident/insurance clients, for some reason, never seem to improve until their case settles
I prefer clients who take responsibility for their health and are willing to invest in their health and appreciate and utilize alternative therapies.

anyway - if you are in a state that you can be a provider then it looks like you would have a lot of business.
You are not competing with the chiropractor - because you are not offering chiropractic care.

 

[Ray <3]

How to compete with Chiros who bill insurance for massage

I am competing with the chiros ability to bill for massage because they can write a script stating that it is medically necessary. However, clients that are truly in pain will pay what they can just to feel better. I have had a few people see me at the spa that i used to work on in other clinics, because "the new person doesnt do it like you do." That always makes me feel good. It's just a slow process I suppose.

 

[JoshuaEvanss]

How to compete with Chiros who bill insurance for massage

We don't bill insurance for any of the work we do. Lots of people have asked, but we have refused to go down that road. We have some MTs and receptionists that could learn how to do some of the extra steps involved with insurance billing, but we don't feel it is worth the hassle of that learning curve, nor do we have any desire to add more layers of paperwork to our workload. Instead, all of our clients pay out-of-pocket at the time of service. If they wish, we print them an invoice which they can submit for insurance reimbursement. If they have a willing medical provider, we invite them to bring in a written prescription/referral, which we retain with their client records. While we have a valid prescription/referral on file, we invoice all massages as Rx Massage. This seems to help them get reimbursed in a timely fashion without any more effort on our part.

Some of our clients have Visa/Mastercard HSA/flex spending cards. We swipe them just like regular credit cards, and most of the time they work just fine. Though it's not really insurance billing, it satisfies many of our clients. If a card won't work for some reason, we obtain another form of payment and print them an invoice for reimbursement.

Do we lose work because we don't bill insurance? Yes, absolutely. But we are doing well and seeking to hire more MTs to meet demand. Considering how busy Kelly and I (co-owners) are already, we simply don't feel that the extra time it would take to learn the systems, retrain our existing employees, educate our clients, implement additional billing and tracking systems, follow up with insurance providers and clients, etcetera... would be sufficiently compensated.

Perhaps if it was ONLY the two of us, we might give it a shot, because Kelly and I are well-known for our "medical" massage abilities. I *have* considered trying it, with the requirement that I be the only MT working with insurance clients, but I'd still be faced with all of the extra steps and outlays of time noted above... not worth it at this time.

So far, we are doing well enough that several local chiros have stopped having MTs (ICs or employees), and they now refer to us. Some of them started referring to us when they noticed that their patients did much better with our MTs than with their in-office MTs. Others simply got tired of dealing with "MT drama" or whatever other bad experiences they had with MTs.

Part of our success in attracting referrals has been our willingness to initiate friendly, open dialogues about the way local chiros, MDs, PTs, etc. work. We learn about them, and in the process they start learning about us. As they realize the differences between what they usually experience with MTs and what kind of experience we provide, trust forms and they start sending their patients to us. Kelly and I offer them a free massage (with one of us, of course) so they can have the whole client experience and understand how we treat the people they entrust to us. The experience includes having them fill out our health intake, go through a whole intake/assessment, and everything else we would normally do. Some have elected to keep coming as regular clients.

You CAN compete successfully against those who bill insurance, but it takes time and dedication and some people skills. Study those you compete against and learn how to educate people about what you do that makes your work a worthwhile investment. Study the environment in which you work and what the client experience is like to find opportunities to improve their perceptions of you and the work you do. See if you can engage the owner in this process, as teamwork will increase your chances of success.

 

[StrongGIRL]

How to compete with Chiros who bill insurance for massage

Thank you for that excellent post Jason. That is very encouraging. I have sent a few "free one hour massage" gift cert to local chiros, however as of yet, none has taken me up on it. I do have a client who is a neurologist who said they would refer patients to me and an sports medicine doc who has said the same. Still haven't seen anyone from either one of them. It seems that every seed I plant takes about 3 months to bloom though. So they still have a couple of months I guess. Do you have a step by step strategy for opening a dialoge with other medical practicioners? For example, do you send them a portfolio, contact them by phone (I have never been able to get past the office manager), do you contact them by email? I use eric dalton's 5 minute accessment strategy for my med massage clients. I keep notes for my on plan of care now, but have yet to become part of a care team.

 

[Laurie]

How to compete with Chiros who bill insurance for massage

Thank you for that excellent post Jason. That is very encouraging. I have sent a few "free one hour massage" gift cert to local chiros, however as of yet, none has taken me up on it. I do have a client who is a neurologist who said they would refer patients to me and an sports medicine doc who has said the same. Still haven't seen anyone from either one of them. It seems that every seed I plant takes about 3 months to bloom though. So they still have a couple of months I guess. Do you have a step by step strategy for opening a dialoge with other medical practicioners? For example, do you send them a portfolio, contact them by phone (I have never been able to get past the office manager), do you contact them by email? I use eric dalton's 5 minute accessment strategy for my med massage clients. I keep notes for my on plan of care now, but have yet to become part of a care team.

No, I don't have a sure-fire step-by-step strategy. I have tried various approaches with mixed results. Our most frequent referral sources are medical providers who heard about us from their patients. Some of them have been intrigued enough to contact us; some have even come to see us themselves, and some of those keep coming back. Those who don't return do, however, send us their patients now and then.

I have found it helpful to ask questions about what they do, what kinds of patients they see and what sorts of things they refer out. I have found it helpful to make a personal contact at least once, but ONLY if I was professionally attired and presented myself in a professional manner. I have found it helpful to call ahead and find out who I need to meet with, as sometimes an office manager or professional liaison person will be the key contact. I have found it helpful to make appointments rather than drop in unexpectedly. I have found it helpful to always have some printed materials about our business, and some business cards, when meeting with the key person/people. I have occasionally (but not always) found it helpful to offer a free massage (with myself or Kelly, my partner). I have occasionally found it helpful to follow up with phone calls, letters, e-mails, etc. I have found it helpful to focus on evidence-based benefits of massage. I have found it helpful to use proper medical terminology. I have found it helpful to avoid making any grand claims about the results our clients get with massage. I have found it helpful to avoid making any grand claims about massage education/certifications/etc. I have found it helpful to approach with a measure of deference, granting them some additional respect due to their title. (NOTE: deference and respect = good manners, NOT capitulation and sucking-up.) I have found it helpful to approach networking like farming: plant seeds, fertilize, see what comes of it, repeat regularly, and learn from mistakes made/triumphs achieved along the way.

Hmmm... maybe I should rewrite that into a 150-250 page book and sell it? Oh wait, that's been done...

 

[roro]

How to compete with Chiros who bill insurance for massage

I bill for auto injury and it is about 1/4 of my practice and is does take some getting used to. You need to learn how to play by the insurance co. rules. However I would have to say that it take just as much effort/energy with an insurance client vs. a cash client to get them in the door, the process is just different.


And generally a Dr. will write an Rx for a massage because my client ask for it. And I take that chance to call the Dr. office. I almost never get the Dr. on the phone, so I talk to his/her nurse about the Rx. I give the nurse the 411 why the client as for the Rx. And I make sure the nurse has all my contact information and I let them know I would be more than happy to write a progress report on the mutual patient at the Dr. request.


And as far as chiro go in my area I book an appointment for an adjustment. That way I know what kind of work they offer so I can make the best match for my clients.