ADVOCATE FOR MASSAGE THERAPY AS A RECOGNIZED & RESPECTED HEALTHCARE PROFESSION
By Dagmar Growe, LMT
I have been honored to serve my profession and my fellow massage therapists for the past 7 years as a board member of WSMTA. I love the connection to the amazing people who are leading this organization, and our members. When I started I didn’t know what a WAC was (the rules that govern our profession), or how to find them. My insurance billing was based on a mixture of rumor and guessing. And I felt a sense of isolation, as I was practicing mostly on my own. Stepping up and volunteering for WSMTA has been a huge benefit for me.
I am now in what I hope will be a drawn out final stage of a 30+ year career. As I am shifting my focus to things other than work and family, I have decreased my work time and canceled my health insurance contracts. I am traveling a lot and keep missing WSMTA meetings. I am losing my enthusiasm for taking on insurance companies.
Many of the folks who guide and protect our profession through their volunteer service for WSMTA, AMTA-WA, or the Board of Massage, have done this for 30+ years. They have brought us from being an obscure profession with a dubious reputation into the 21st century: We are accepted as healthcare providers, our patients seek our expertise for their health issues, doctors refer to us, and yes, well, insurance companies reimburse for our services – kind of. None of this has come easy, every step was fought for, and there is a constant pressure all around us to reverse this progress. Municipalities write codes that discriminate and aim to limit our scope of practice in the name of fighting human trafficking. Insurance companies try to limit coverage for massage therapy, or to make processes so cumbersome that we would give up and go away. I believe massage therapy as a healthcare modality does not have a future unless we keep fighting for it. There is an urgent need for younger therapists to be trained to step in to take our place as this current generation of therapists transitions out.
I have therefore decided to step down from my position as a WSMTA Board member and make room for someone who has a longer professional life ahead of them, and more energy and investment. Please notice that I did not mention “more time”, as just about nobody I know has extra time on their hands. However, a wise friend of mine once told me: “I don’t have time, I make time. For what’s important to me.” And my profession has always been important to me. I am planning to continue to be involved actively, mentoring younger therapists, giving more of my attention to South Sound LMTs, a local networking group that I have been part of since I first got licensed, and you might see the one or other article I feel compelled to write for WSMTA. As a lifetime member I will continue to be part of it, giving my time to the occasional project.
What does this position entail? Board members are also part of one of our programs (in my case Clinical Practice, there are also Membership and Government Relations). That’s 2 phone or zoom meetings a month, a total of about 4 hours, which count towards your continuing education hours. Whatever board members contribute beyond those meetings is mostly based on their interests and the time they are able to make available. My contribution has mostly consisted of writing articles, researching information, answering member questions, and taking minutes at meetings.
If you do care about our profession, and want to see it thrive in the future I very much encourage you to start volunteering now. Bylaws require that members serve actively for 6 months on one of the programs before being eligible to serve as a director. Please do not hesitate to nominate yourself or contact us to let us know in what function or area you would like to volunteer. Your service is needed to ensure the viability of our profession in the future.
REGISTER HERE
This is an affordable opportunity for a group legal consult with John Conniff, a highly knowledgeable and experienced healthcare attorney. John provided a comprehensive review & analysis of the Regence Provider Agreement in 2022.
This webinar is interactive, focusing on our shared concerns as well as your specific questions regarding the Regence Provider Agreement.
Our goal is to understand the provisions and requirements stated in a provider agreement before we sign it and gain knowledge to question provisions that are not in our best interests or even legal.
An example is Regence declares the contract itself is "confidential and proprietary", it is not. In addition, there is contract language that conflicts with Washington State law. Washington State law supersedes the contract language.
Please join us for an interesting and useful workshop on a topic that affects all insurance providers.
This webinar satisfies the Washington State 4-hour ethics requirement.
Dates: Monday, September 18th, 2023 from 7 - 9pm for Session 1 and TBD for Session 2. Registration closes on September 11th.
Location: Live Webinar via Zoom
Cost: $120 for those who have already purchased the Regence Provider Agreement review done by John Conniff. $220 for those who have not previously purchased the review document – the price includes the $100 review document.
CE Hours: 4
Register Here
by Elizabeth Jane Brooks, LMT, BCTMB
If you have contracted with an insurance carrier there may come a time when you wish to terminate that contract. Following are some suggested steps for getting this accomplished.
1. Obtain access to your contract
When the decision has been made, you need to look at the requirements in your specific contract. If you have a copy of your contract, this is easy. For many, you will need to obtain a link from the insurance carrier with an access code to open the contract file online. Contacting your insurer’s representative, or your Provider Relations Representative (if they have one), is an effective way to do this.
2. Locate termination requirements
Once you have your contract, locate the section on terminations to find the exact requirements. Some things you need to know are:
Do you need to send a certified letter?
What needs to be stated in your letter?
Where to send your letter?
To whom should this letter be addressed?
How much notice must be given?
Keep in mind, termination must be done in writing. For this, sending it by Certified Mail is a great way to prove the writing was both sent and received. In addition to notifying the insurance carrier, if there is an administrator for the insurance, such as Tivity/WholeHealth or Community Health Plan, they will also need to be notified.
Below is a sample letter that you can tailor to your situation and use for termination. It has not been reviewed by an attorney, however, it is what a current member used to successfully terminate their own contract. Remember, your contract will tell you exactly what needs to be included in your letter of termination.
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Attn: [Department, representative, etc.]
BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED
To Whom It May Concern:
This letter constitutes notice that I am voluntarily terminating my contract with your company and all its affiliates at the earliest date allowed by the contract. [Reason for terminating.] Thank you for the many years of partnership. My NPI number is [XXXXXXXXXX].
Immediately upon the effective date of this termination, I will then be out of network with your company, and all patients in your plans will be expected to pay my out-of-network fees.
Please let me know promptly if you have any additional requirements concerning my contract termination.
Sincerely,
[Full name], LMT
WSMTA hopes you find this information useful, and we acknowledge that understanding contracts can be challenging. If you still have questions or concerns regarding terminating properly, it would be wise to consult your attorney.
We at WSMTA do our best to stay on top of the latest news in massage, especially as it relates to laws, insurance, and business. We hope you find the articles on the website helpful (mywsmta.org). We also hope that you will consider joining us as a volunteer—you will make strong connections, gain support, and be at the forefront of the massage industry!
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SAVE THE DATE
Understanding Healthcare Contracts
New May TBD via Zoom
2 CE's
Excellent opportunity to consult directly with John Conniff, healthcare attorney, who provided a comprehensive review of the Regence Provider Agreement. Get your questions answered, understand provisions and requirements included, some of which are not enforceable. More information to follow. The Regence contract review can be purchased on our website.
Here in the US our economic system is unapologetically based on the tenets of capitalism: The maximization of profit and a free market to manage the distribution of resources. In many ways this works really well. Cousins of mine who lived under the planned economy of former Eastern Germany will assure you as much.
Massage therapy, the self pay kind, is a good example. Prices are based on a variety of things: The quality of massage and marketing skills of the therapist, and the economic makeup of the clientele. Are you working at an upscale spa in an affluent area, or in a small town with low wage jobs? Are you trying to fill your schedule, or trying to work less? Lower or raise your prices, and things will sort themselves out accordingly, at least in theory.
But there are some conditions under which this system is bound to fail. First, if a person's life depends on a product, like food, housing, or medical care, then they are forced to pay whatever the asking price is. This situation is more akin to blackmail than a free exchange of goods. We are seeing some of this with housing and pharmaceuticals.
Secondly, a functioning free market depends on multiple participants to allow for competition. Many areas have 1 or 2 insurance companies that dominate the local market. This lack of competition allows them to take an attitude of "Take it or Leave it" with providers. And as we have repeatedly pointed out, in the name of free market competition, individual providers are banned from uniting for the purpose of negotiating better pay. This puts big health care organizations at an advantage as they too have regional monopolies and can use those to negotiate individual contracts for their organizations. Unfortunately, non-allopathic care is not generally of interest to those organizations.
And finally, the insurance system puts multiple middle agents between the provider and the patient (aka the "consumer"). If I provide massages to self paying patients those patients are my customers. They get to decide if my treatments are worth the price. Interestingly, if I provide a treatment under an insurance contract, that patient is no longer my customer, the insurance company is. And even more complex, the insurance company's customer is not my patient but the HR Department of my patient's employer. And in some way, the employee could be seen as the customer of their employer. This is where profit, or savings, maximization come in. The HR Department wants to buy a health plan for the lowest price they can get that still satisfies their employees needs to some extent. The insurance company calculates their prices to be competitive, while at the same time profiting as much as possible, meaning paying out as little as possible. Patient and provider actually have no relationship at all in an economic sense. The patient has to take whatever provider is contracted with the plan, and the provider has to accept whatever rates the insurance company offers or cancel their contract..
Where does that leave us? Any change needs to follow the convoluted path of market place relations. Once employees (who are allowed to organize) complain to their HR departments about the lack of an adequate network, then it could be hoped that HR departments would put pressure on insurance companies to improve their network. And if insurance companies cannot find sufficient providers at the rate they offer, then and only then would there be an incentive to raise reimbursement rates. Massage therapists keep asking the question: When will insurance companies increase their rates? And here is the answer: Why should they? They are for profit businesses, maximizing profits, which is exactly what their shareholders want them to do.
So what can we as providers do: First, we can refuse contracts that do not offer us a living wage. As long as a sufficient number (by whatever standards) of massage therapists are willing to accept current rates there is no need to change, from the perspective of the insurance companies. Being a contracted provider but limiting the number of patients one is willing to treat under a certain plan is both a contract violation under most contracts, and inflates the number of therapists available in a network. Secondly, we need to educate our patients why we are not accepting their insurance, both for financial and administrative hassle reasons. We need to encourage them to document their difficulty finding a provider, and complain to their HR departments and the Office of the Insurance Commissioner (OIC) if they cannot get the care their health plan offers. Third, LMTs need to increase their level of political involvement. Most healthcare provider associations spend tens or hundreds of thousands of dollars on lobbyists. They get that money from their members who recognize the importance of having their interests protected. If you have been around long enough you may remember Insurance Commissioner Deborah Senn who brought complementary care into the mainstream. She was elected with a lot of support from professional organizations.
It is important to keep in mind that everything will be a slow uphill battle every step of the way because the system is not meant to provide healthcare but to provide profit. But to do nothing means giving up on massage therapy as a healthcare modality being offered on par with other modalities. We have gained so much in the last 30 years - let’s make sure we don’t lose it.
And lastly, here is one piece of good news: As of the publication of this article - House Bill 1655 is being considered by the legislature. The bill recognizes that small groups and individual providers have no power within the system to negotiate reimbursement rates, and requires automatic cost-of-living increases. Please follow the bill’s progress and contact your legislator if the bill makes it to the voting stage. Watch your WSMTA mails for updates.
LMTs will likely see an increase in Uniform Medical insured patients looking for a United Healthcare provider. Premiums for Regence Uniform plans for retired members for 2023 have increased significantly so people are looking for cheaper options, one of which is United Healthcare. Please note that
United Healthcare is separate from Regence. This means you have to apply to them to be a provider. It also means you should not expect that their reimbursement rate is the same.
Some United Healthcare Uniform plans do not cover massage therapy. Uniform Medical is a self-insured plan. It is a trust fund for health care expenses financed by the State of Washington for its employees, rather than coverage bought from an insurance company. However, Uniform hires insurance companies to administer the trust fund. These plans are regulated by ERISA (Employee Retirement Income Security Act of 1974, a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans). Because federal law supersedes state law, Washington’s every-category-of-provider provision does not apply to these plans. They may opt to provide massage therapy benefits or not, and they can apply additional rules which are not always clear. We know of at least one plan that offers benefits for acupuncture and chiropractic care but not for massage therapy.
Some plans may offer the option of out-of-network benefits, allowing you to bill even if you are not a provider. This usually offers better pay because you have not agreed to the company’s rates. You can also offer to provide the client with a billing statement or receipt so they can apply for reimbursement if the plan allows.
Remember HSAs (Healthcare Savings Accounts) and FSAs (Flexible Spending Accounts) . You can offer to accept payment through those if you are set up to accept credit cards. Make sure you are registered as a healthcare provider with your payment processor.
As always, if you choose not to be a provider, educate the client about your reasons. I have found that most patients are appalled when I tell them what the insurance companies would pay me and how much work would be involved.
By Joshua Elan & Susan Rosen
Of course we have basic personal information and health history, and these days we have Covid policies. We've always had a bit about our office policies, but it was time to rethink what might have once been either too brief or overly convoluted.
In that spirit, we have been developing a document to clarify our framework of care goals. One primary concern is clarity of communication. One key element of communication is an explanation of what constitutes care, the LMT’s responsibilities and the patient’s responsibilities therein. Another vital piece is to make more clear the facts and expectations of insurance billing for those that are utilizing insurance.
Combining and clarifying our office policies into one more vital - and easy to read document has been a long time coming, and we hope you like the result. We are about to begin 'road testing' this new part of intake with patients, but it is not set in stone: we welcome your thoughts on how to make our intake paperwork process even better.
SRA Philosophy of Care Draft 5a - Google Docs.pdf
By Elizabeth Jane Brooks, LMT, BCTMB and Dagmar Growe, LMT
We at WSMTA hear many complaints from massage therapists regarding how difficult it is to make enough money to support themselves and their families through massage. As seasoned massage therapists, we would like to pass along some advice which we hope you will find helpful.
With massage there are basically two paths to earning money, working for someone else or working for yourself. Another way to look at it is, there’s the easier way and the harder way. Let’s examine the two paths.
The Two Paths
When we first graduate from massage school we have some knowledge but we are inexperienced. A great way to gain experience is to work for someone else, such as a clinic or a spa. They can send you a steady stream of patients, helping you to gain experience. This usually comes at the cost of low pay (anywhere from $15 to $40 per massage). Therapists that stay working in this type of arrangement tend to overwork trying to make ends meet. Many therapists become burned out or injured, and end up leaving the profession.
If the newly graduated massage therapist decides to work for themself, the struggle is in getting a steady stream of patients. However, if they are able to gain a few good sources for referrals to their practice, the income will be much higher than what is received if working for someone else. This, too, comes with the cost of having to learn all the behind-the-scenes work like setting up a business, advertising, purchasing, billing, taxes, etc., all at once and often in isolation.
For most therapists, working for someone else is easier at first, but in the long run it is more strenuous and less financially rewarding. While working for yourself requires an investment of time and energy that is not necessarily immediately rewarded, it eventually offers more freedom, flexibility, and income.
A good suggestion for someone just starting out would be to work for a clinic for 1 to 2 years and then branch out on your own after gaining some experience, because the best way to make a lot of money with massage is by working for yourself. It is not hard to learn how to manage your business but it does take time and steady devotion. Therapists who are willing to do their own scheduling and billing can operate a business at very low cost which means a high profit margin per massage. It does require a certain amount of entrepreneurial spirit and the willingness to manage fluctuating income. Paying for the training you need from those that have successfully created a busy practice, and investing in building one's skills to set oneself apart from the competition, are well worth the money. You will save steps and time, and make even more money than those trying to reinvent the wheel by learning everything on their own.
However, therapists who do not want to work for themselves do have options for increasing their income. Here are some examples:
Branch out and start your own practice part time.
Remain working for your employer and negotiate a raise for your work.
Get a job working at a high end spa, which normally pays better, plus, the tips are usually quite generous.
Charge for extras, like hot stones, arnica application, aromatherapy, herbal packs, etc., and negotiate with your employer that the income generated goes to you not the employer.
Where it All Leads
It is interesting to note that the entire field of massage therapy over the last 20 or so years has shifted from predominantly self-employment or independent contractors to employment. Some of this has been driven by legal changes, specifically enforcement of labor laws regarding independent contractor status. The medical field in general has seen a move towards larger clinics with employed providers - there are hardly any independent doctors or other providers left. What sets us apart from most of the medical field is the fact that our patients are more likely willing to pay out of pocket for our services. In addition, we do not need lots of staff and office space.
However, if less of us are willing to take the risk of independence, if less of us are willing to fight for our profession, to engage and be involved with making the rules that determine our scope of practice and our rights to practice, if more and more of us are happy to let someone else handle these things for us - we may find one day that we will no longer have the opportunity to work on our own. Earning a good living with massage therapy may have become a thing of the past.
We hope this sparks a few ideas to explore and ends with you making the money needed to more than survive, but to actually thrive.
The Washington State Massage Therapy Association (WSMTA) is conducting a Medical Insurance Survey to determine if they are maintaining an accurate provider directory of contracted, active licensed massage therapists in our state. This directory must be updated monthly and certified with the OIC that it is current and accurate in accordance with WA state law. This directory is also the foundation to know if there are enough credentialed massage therapists with current, signed contracts in each region of our state with each medical insurer.
With the input of the Office of the Insurance Commissioner (OIC), the WSMTA is going to conduct a survey in November to check the accuracy of these directories. We need volunteers to help. There will be a brief training the first week of November via Zoom, volunteers will be given the entire month of November and part of December to call as many practitioners listed in the directories as they are able and they will document the accuracy of the information. The more volunteers we have, the more practitioners we can call, the more regions we can cover and a more accurate accounting will be gained. You will not need to travel to volunteer. Training will be done via Zoom. You will need a phone, computer and internet connection to participate in the project. Calls can be made in your free time. The project has a hard deadline in mid-December when your time will no longer be needed. You do not need to be a massage therapist to volunteer. If you know of anyone that may be interested in helping – clients, friends of massage therapy, retired parents, they are welcome as well.
To volunteer or for more information, please contact Julie Johnson at jjohnson@myWSMTA.org with the subject “Volunteer for WSMTA Insurance Audit”.
If you are unable to volunteer for this project, you can still be an active participant in our efforts with medical insurance companies.
- Make sure your information in the Provider Directories is accurate and get it updated if necessary.
- Canceling your contract? This must be in writing and tell them WHY. If you do not cancel in writing, you are still considered a contracted provider.
- Unhappy with your agreement, communicate and negotiate. Assume they need YOU. Don’t give up!
- Unhappy Clients/Patients, tell them why you’ve stopped accepting the insurance or are no longer accepting new patients. Encourage them to contact their insurer. If they are experiencing a delay in their care or are unable to find a practitioner in their area, they should contact the OIC. The OIC is there to advocate for the insurance consumer - not the practitioner - not us. Until patients complain about their inability to get access to massage services, nothing will change. YOU need to explain this to them and ask them to act. They can also volunteer for our insurance survey. Have them contact Julie Johnson at jjohnson@myWSMTA.org. .
- Go forth and share this with all WA Massage Therapists!
Jane Brooks wrote an excellent article on Insurance Network Adequacy which inspired this insurance survey effort.
By Robbin Blake
Currently, Monkey Pox (MPV) is in the news and WSMTA has received quite a few questions about it. The Washington State Department of Health (DOH) has a website page that provides very thorough information about the virus – you can see pictures of what it looks like, read about how and where it is spread and what to do if you are exposed. Fortunately, the virus has very defining characteristics and is mostly transmitted with direct contact. From the information on the DOH website you can create intake questions if you feel that you have the possibility to be exposed. If you feel that the person on your massage table may have MPV then do exercise your pathogen protocols that you have in place for handling linens the person came into contact with, disinfecting equipment in the room and washing your hands and forearms. As we are required to wear masks during massage still at this point, this protects against the smaller possibility of airborne transmission.
For details about the monkey pox virus, please see the following websites:
DOH: https://doh.wa.gov/you-and-your-family/illness-and-disease-z/monkeypox
CDC: https://www.cdc.gov/poxvirus/monkeypox/index.html
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Advocate for Massage Therapy as a Recognized & Respected Healthcare Profession
