Insurance Billing
Types of Insurance We Bill & How to Check Benefits. ​
Car Accident/ Personal Injury Claims:
1. Get a prescription for massage therapy including diagnosis codes (ideally written out and also in ICD-10 form), frequency of visits ordered, expiration date and referring provider information from your doctor, chiropractor or other insurance-approved primary provider for your case.
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2. Schedule your appointment & fill out the required intake forms before we start. They will be sent via email through my scheduling platform and you can fill them in electronically.
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3. Bring to your appointment:
A. Your insurance information and information on the insurance we are billing if not your company.
B. Claim number
C. Adjuster's name, phone and email.
D. Your completed intake forms or information needed to fill them out at the office.
Private Health Insurance:
Most companies cover up to 60 minutes of treatment. On very rare occasions, we may get 90 minutes covered but not usually more than that. For any treatments lasting over 60 minutes we treat the first hour as an insurance visit and the rest of the time you pay out of pocket at the time of service. Ex: 90 min visit = Your out of pocket responsibility for 1 hr + cost of 30 min.
In Network Billing:
Regence Blue Cross/ Blue Shield only.
Benefits not confirmed will be treated as Out of Network Billing until confirmed. Any fees paid to the office will be credited to you or refunded.
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Out of Network Billing:
If you have benefits but I'm not in network, I can provide you with a medical receipt that you submit for reimbursement. Usually this is the least hassle for everyone.
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I may choose to bill directly to the company on a case by case basis. Mostly this just makes more work for me and more cost to you. ​
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* Please note I left the Kaiser panel years ago. I cannot bill for services and you will not be reimbursed by them for fees paid to me.
How to Check Benefits
1. Call the toll-free number on your insurance card and ask to talk to a member services representative.
ALWAYS WRITE DOWN date & time of your calls & name of person who helped you.
They may need your:
Name -- Date of Birth -- Insurance ID# and Group ID#
and any other information that they can use to verify your identity (i.e. SSN or passwords).
Questions to ask:
Is massage covered BY A MASSAGE THERAPIST?
(Some plans cover massage given in a doctor's or chiropractor's office but NOT by a massage therapist billing under their own license).
What procedure codes are covered? I can bill 97124 and 97140. Once every few blue moons 97110 eval might be covered.
Do I need a referral or prescription? Who is authorized to write it (doctor, chiropractor, other provider)?
Do I need pre-authorization for visits?
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Is there a limit to the number of visits or spending cap allowed per year? Is that shared with other services? How much has been used so far this year?
Is the insurance year measured by the calendar year (Jan 1-Dec 31) or by different dates (ex: Sept 1-Aug 31)?
Do I owe a co-pay or coinsurance at the time of service? How much?
Is there a deductible that applies to massage therapy? Is that shared with other services like acupuncture, chiropractic, naturopathic, physical therapy? How much has been applied to the deductible this year?
How much time is allowed per visit? (Most companies reimburse up to 60 minutes, some may cover longer with documentation but it's tricky and I cannot guarantee payment.)
If I see an out of network provider (specify service, i.e. massage, acupuncture, etc) what is the reimbursement rate?
If you are interested in acupuncture, naturopathic, chiropractic, counseling, etc. it’s good to get the same information about them while on the line.
Remember, even if you verify coverage, this is not necessarily a guarantee of payment. Try to find out to the best of your abilities what your insurance company will and will not authorize in order to reduce your chances of getting a surprise bill. You will be responsible for any charges not covered by insurance.