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Success: Insurance Reimbursement is Finally Increasing!

24 Aug 2023 11:56 AM | WSMTA (Administrator)

By Dagmar Growe, LMT

When WSMTA was founded in 2015, two of our goals were to work with insurance companies toward making processes less cumbersome for LMTs and patients, and to work toward a badly needed increase in reimbursement rates. Most of our founding members had been around since the late 1990s when insurance companies sought out their advice on how to implement the new requirements to cover massage therapy and we were hoping to build on those relationships.

Almost immediately after our founding, we had to face some difficult facts, WSMTA learned that advocating for a rate increase as an organization would be a violation of antitrust law. We also learned that insurance companies were not at all interested in communicating with anyone to help solve problems with procedures. Provider reps changed frequently so we were not able to build consistent relationships. Supervisors made themselves unavailable. In fact, with some health insurance companies, it seemed that not resolving problems was part of a strategy to discourage enrollees from using benefits, and to encourage massage therapists to withdraw from networks.

WSMTA had to change strategies, so we started to focus on alternative payment options and the issue of provider network adequacy - or the lack thereof. We focused on the following:

  • Educating massage therapists about accessing patient benefits and payment through their flexible health savings accounts.

  • Encouraging massage therapists to do a cost analysis so that individual businesses could assess if being a provider for a health insurance company was economically viable for their business.

  • Educating massage therapists about contract violations. For contracted providers, it will generally be a contract violation to deny appointments to insured patients while offering them to non-insured clients.  We encouraged massage therapists to choose between either honoring their contracts or canceling them in order to avoid violations.

  • Encouraging massage therapists to have their patients complain to their HR Departments and the Office of the Insurance Commissioner (OIC) if they were unable to obtain treatment in a reasonable timeframe.

  • Conducting an audit last fall, with a handful of dedicated volunteers, of one insurance company’s massage therapy provider directory.  WSMTA found that the directory was inflated due to duplicate provider listings, listings of providers no longer contracted or not taking insurance any more, and retired LMT’s. We shared our findings with that insurance company, the OIC, and all legislative representatives on healthcare committees. And, we informed a number of other companies that we were planning on conducting similar audits of their directories.

And finally, this summer, everyone’s efforts have started bearing some fruit. After years of mainly decreasing rates, Kaiser announced a rate increase. Regence has also announced a rate increase, (although they moved all 3 CPT codes that LMTs were using to the same reimbursement level so therapists who were eligible to use and have been using 97112 will not see much of an increase). 

We are proud of this achievement which is shared by WSMTA and all massage therapists who did their own homework, said no to unsustainable rates and decided for themselves what worked best for their business. For many, this meant taking what could feel like a risky step by canceling their contracts rather than continuing to hold out in hopes that things might somehow get better on their own. Thank you also to massage therapy patients who lobbied their insurance carriers to increase treatment access. It is our hope that the remaining health insurance companies will realize that they cannot find providers unless they are willing to reimburse us at an acceptable rate.

These changes did not happen because insurance companies saw the light and wanted us to receive fair pay. It happened because LMT’s educated themselves and took action. Thank you to all of you who have worked behind the scenes for these changes. And, if you are not yet a member of WSMTA, I do encourage you to join today both as a member and a volunteer. Improvements happen, but they do not happen unless we are willing to fight for them!

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