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Insurance Billing

Below you can find a guide to the kinds of insurance I can take and how to check your benefits.

 

Please note:

I accept Auto Accident claims and health insurance listed below.

 

If your coverage is not confirmed or your network does not cover me, I am happy to provide you with a detailed receipt when you pay out of pocket. Then you can request reimbursement from your insurance company. Sometimes this is cheaper for you than having me bill. 

Car Accident/ Personal Injury Claims

What to do: 

A. 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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B. 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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C. Bring to your appointment: 

-Your insurance information and information on the insurance we are billing if not your company. 

-Claim number

-Adjuster's name and contact information

-Your completed intake forms or information needed to fill them out at the office.

Private Health Insurance

**I no longer accept Kaiser's CHP as of September 1, 2021.

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--Regence Blue Cross: I am a preferred provider. Both locations are listed.

(includes Blue Cross, Premera and several others). If you have a Regence insurance you may need prior authorization for treatment to be covered. Please check your plan.

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OUT OF NETWORK:

If your plan covers massage but I am not on the panel, I can give you medical receipts for you to submit for reimbursement. I have seen people have success with:

-MODA

-United Health Care

-Other companies on a case by case basis

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-Pacific Source: I was on the panel for about a week before getting notice that they changed their business structure and now they are governed by Kaiser, whose panel I have left. Since then, I have billed Pacific Source as an out of network provider with success, however this ability depends on the plan. In most cases, I'll likely have you pay out of pocket and submit a receipt for reimbursement. In some cases I can bill as in network. I can either reimburse you or credit your account for any expenses that insurance covers. 

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Most insurance covers a limit of one hour (4 units of 15 minutes) but occasionally they cover longer sessions. Double check your benefits for session length restrictions. 

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If you wish for more time than insurance allows, you can pay out of pocket for the extra time. For example, if you have a 90 minute appointment and one hour is covered, the normal copay/ coinsurance applies to the first hour and you pay the out-of-pocket price for the extra 30 minutes.

How To Check Your Benefits

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 by a doctor or chiropractor but NOT by a massage therapist)

  • What procedure codes are covered? I can bill 97124 and 97140. Occasionally 97110 eval will 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? 

  • 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?

  • Is there a limit to the number of visits allowed per year? Is that shared with other services?

  • How much time is allowed per visit? (Most companies reimburse up to 60 minutes, some longer) 

  • Is there an annual dollar limit for massage? Is that shared with other services?

  • How much has been used? 

  • If I see an out of network provider (specify service, i.e. massage, acupuncture, etc) what is the reimbursement?

  • 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.

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