Insurance Ethics!

A discussion board for matters relating to appropriate business and practice ethics, matters regarding conduct of clients and practitioners as well as a place to discuss dilemmas that cross our paths.

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Insurance Ethics!

Postby jdcan on Sat Oct 14, 2017 12:56 pm

A client whom I originally told that I don't handle insurance paid me my normal rate by checks for several sessions.

She is now asking for receipts, notes, codes and diagnosis so she can submit these to her insurance company for reimbursement.

It is my understanding that I will need to let her know that only a Doctor can diagnose. I'm unsure about the CPT codes. I was told by another Clinic office manager in a different establishment that I can't give her codes because I didn't charge her insurance rates, only my much lower hourly rate. Also, I have not learned about codes and want to stay out of hot water!

Advice Please!
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Re: Insurance Ethics!

Postby pueppi on Sat Oct 28, 2017 9:28 am

jdcan wrote:A client whom I originally told that I don't handle insurance paid me my normal rate by checks for several sessions.

She is now asking for receipts, notes, codes and diagnosis so she can submit these to her insurance company for reimbursement.

It is my understanding that I will need to let her know that only a Doctor can diagnose. I'm unsure about the CPT codes. I was told by another Clinic office manager in a different establishment that I can't give her codes because I didn't charge her insurance rates, only my much lower hourly rate. Also, I have not learned about codes and want to stay out of hot water!

Advice Please!



I will say out loud... I don't like it when I tell someone I don't handle insurance, and then they come back and want me to. I've yet to find my voice in regard to that. But, I am sending you a PM with more specific information that don't want to get into it on open forum. ;)
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Re: Insurance Ethics!

Postby tranquilspirit2006 on Mon Oct 30, 2017 4:18 pm

I have a part of my intake form that addresses this. It says (paraphrasing here) that I do not diagnose or treat diagnosed conditions, I do not accept prescriptions and I do not bill insurance companies. I had someone do almost the exact same thing to me and I reiterated politely that I had told her I did not bill insurance or work off prescriptions, that insurance will not reimburse as I am a CMT (DE has a two-tiered licensing system. I have the training, I just never took a national exam, although I am licensed by the state) and that she signed the intake form indicating she had read and understood this on the intake form she signed. I never heard from her again, which was fine with me.

I had another client years ago, same situation although I had given them a simple receipt as requested (as I would for any client who asked for one, but it simply noted that payment had been received for a one hour combined Swedish/deep tissue massage). I got a call from their insurance company asking for SOAP notes, and I explained the situation to her and told her the client has also been informed of this, at intake and again during a discussion. She understood and that was that.

People who do this bug me.
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Re: Insurance Ethics!

Postby JLWmassage on Tue Oct 31, 2017 5:56 am

I don't bill insurance anymore became such a PIA. So what I offer is to send and invoice of when the massages took place and cost. And the client needs to get Rx from their doctor. Going to the doctor for an Rx usually keeps those types of clients away ;)

Or I suggest if they want insurance to pay for MFR or CST they need to go to a PT that offers this and bill their insurance that way. Another option is having the client call their insurance company to find a massage therapist who is in their network.
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Re: Insurance Ethics!

Postby jdcan on Wed Nov 01, 2017 7:55 am

Thank you both for your advice.

I only provided the client with receipts and SOAP notes. I don't anticipate her rebooking. That's best for both of us.
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