Wednesday, February 01, 2006

Referral vs. Diagnosis Codes (Two different things)

I am SO tired of people calling me asking for massage by way of their insurance, and giving me grief over telling them they need to get diagnosis codes from their doc or chiro. It doesn't help that there are a smattering of massage therapists in this city, who make up their own diagnosis codes and bill the insurance for them. It is NOT within the scope of our practice OR license to diagnose people. You can get SUED for fraud people. Not to mention the fact that if you tell a client they have some sort of "condition", they seek treatment for that condition, the treatment fucks them up - you are BOTH shit outta luck.

And insurance companies don't make it any easier. They tell the clients that they don't need referrals to see me, and this is true. However, a referral and a diagnosis code proving massage is medically necessary, are two completely different things. Do people honestly think that an insurance company is going to pay for any Tom, Dick or Harry to go get a massage a week, and NOT have it be medically necessary? They would go broke.

Ok, end rant. That said, I am VERY thankful for the lovely client who just called me to schedule. After much explanation, and clarification of the LAW, I will be massaging her tomorrow through her insurance.

7 comments:

~A~ said...

"It is NOT within the scope of our practice OR license to diagnose people."

Oh AMEN to that. We have the same "rule". Plus, I loooooooove this one, herbs can not treat or cure a condition, only pharmaceutical chemicals. *ahem* Food and Drug admin did that one.

Anyhooooooo. I'm looking up on that bit about the apple cider vinegar and osteoarthritis. My studies and books do not list apple cider vinegar as a possible protocol. Probably because the recommended lifestyle modification is an alkaline diet, but ACV may be an exception. This is where I will have to do some more research because there's probably some other property in apple cider vinegar that is not in, let's say, red wine vinegar. I use ACV in some of my home remedies for other things both internally and externally as a liniment so I know it's useful.

I have a few recipes if you're interested.

lonna said...

I went through a whole run around with my neurologist using the wrong codes for my treatment. I had to fight for all sorts of things because he chose to use the wrong numbers for what I was having done. It was all so useless anyway. My headaches were probably made worse by worrying about paying the guy.

Stine said...

Yeah, yay for the FDA on that one. I'd be interested in any recipes you had A.

No kidding L, I keep wanting to tell these people, I'm doing this to protect YOU, AND me. Like I said though, sucks that other therapists are undermining what I'm doing because they are breaking the law.

hazel said...

wait. massage therapists take insurance???????????????????

Stine said...

P, many massage therapists do take insurance. It depends on the state you live in. If massage is regulated in your state, and practitioners have to have licenses (it's hard to believe that in some states they still don't need licenses), therapists are usually able to sign up with insurance networks. It depends on your insurance, it depends on whether or not the practitioner is signed up with that network, it depends on whether or not your specific plan covers massage. You will also need to know if there is a copay, if you need a doc's referral, etc.

If you have any specific questions beyond this, feel free to email me. You have my email, yes?

Kodi said...

I have serious space issues, and am afraid of getting a massage. That and I can't stand anyone touching my right knee (I have had several surgeries on it). It would have never occurred to me that insurance could pay for a massage. But now that I think about it, it could be beneficial towards healing and not just a luxury.

Stine said...

Kodi, if you were to get and bodywork on your knee, I would suggest you get some sort of gentle bodywork paradigm such as Craniosacral therapy or Reiki.

You ever want the list as to how massage can help you heal, email me.