Heatlh and Wellness

Does Insurance Cover That?

At a time when healthcare is far from what we need, many providers are opting out of the traditional model and doing their own thing. This new model benefits the patient most of all,  but like all good things, it comes with a price. I'm speaking about insurance. It can be very frustrating when the first question out of a patients mouth is "does insurance cover this?" We get it. It's hard to pay for insurance and then pay for healthcare out of pocket on top of it. We are all in the same boat.

However, the reality is, the traditional model doesn't allow us to provide you with the care you need. Asking you to pay for something that has historically been covered by insurance is not easy.  Asking you to pay for something that doesn't fall into the traditional structure of healthcare isn't easy either. In our case, insurance covers per "unit" of work. To make the math easy one unit is 15min.* Insurance companies force providers to perform services for a "contracted rate", a significant discount, or providers can't participate in billing the insurance plan. Additionally, the provider has to have certain credentials to be allowed to participate in the plan in the first place (that's fair). Unfortunately, that doesn't include licensed massage therapists (LMT's), kinesiologists or fascial stretch therapists (FST), among others. The therapies performed by those professionals are forced to be performed by physical therapists or chiropractors for a certain amount of units in order to be covered by insurance or, in some cases, they cannot be billed at all.**

Like numbers? Here they are: The first unit nets, on average, $15 from the insurance company. The remaining units get $7.50. So, for 4 units, 1 hour session, the practice gets $47.50 from the insurance company. That session can only include certain types of therapy: effleurage, petrissage, tapotment, all basic massage therapy techniques. These covered modalities do not include: thorough assessment, biomechanical assessments, lymphatic and organ assessments, kinesiotape (Rocktape), hot/cold packs, ANF therapy, neuro muscular re-education, fascial stretch therapy--all things we regularly use in a session to treat our patients. Under insurance you would only get a "regular massage" with an extremely limited assessment (if you get one at all), no search for the root cause of your pain, no treatment for the root cause, no stabilization techniques after mobilizing muscles and tissues which were unstable and tight when you came in. Most likely you will feel good for a few hours and then will feel like garbage again and need more treatments. On the clinic side, after paying the therapist, documenting all notes and treatment protocols, insurance billing paperwork, paying taxes and any overhead costs the clinic loses significant money.

As with anything, you get what you pay for.  A few sessions at a higher price may seem crazy at first but will save you money in the long run and get you better faster. Not to mention the use of multiple modalities which wouldn't be covered by insurance anyway. We can decide in the moment what your body needs and address the root issue at each session instead of trying what insurance will cover, knowing it may not work and we will have to see you again to check the next insurance protocol off the list.

We want you to be in charge of your health and preventive care. Health is an investment, not an expense. As with anything, you have to find the people who support you in the way in which you need to be supported. We suggest finding people who work as part of an integrated health care team. We work with chiropractors, sports med MD's, surgeons, PT's, strength and conditioning coaches and other therapists. We specialize in resolving your issue in 4-5 sessions and provide preventive care so you don't have to pay co-pays to see health professionals all year long. Stop trusting your health to the lowest bidder*** and find providers that support your vision of how you want your body to perform not just whether or not they take insurance.

*For any single timed CPT Code in the same day measured in 15 min units, providers bill a single unit for treatment greater than 8 min through and including 22minutes. If the duration of a single modality or procedure in a day is greater than or equal to 23 min through and including 37 min, 2 units should be billed. 

**Laws vary per state and some states allow LMT's to provide massage in a clinical setting with billing paid by insurance. Most states require some measure of the work to be done by DC or PT and only 2 units per session billed to insurance if performed by LMT.

***Some wording in this blog taken directly from @atxtherapy instagram post.