I just do insurance massages, I don’t bill for them (thank the Gods). My wonderful boss is the one who walks the labyrinth on that one. So I was perplexed last week when a regular client came in feeling a touch irritated and betrayed about being billed for entire insurance sessions at the chiropractor’s office.
This gets a bit complicated, so let me elaborate. I was the one who referred the client to this particular chiropractor in the first place, and she loves his adjustment. I see him as a client myself, and also appreciate him as a skilled and honest practitioner . . . of chiropractic medicine. Now, I knew he employed a massage therapist who did a short kind of “spot” massage or chair massage to loosen up the muscles before adjustment. But I’ve never gotten one of these massages myself–partly because I call short chair massage “tease massage”–and I guess I never thought about how they were being billed. Maybe I didn’t even think they were being billed at all, just being offered as a nice extra, like a hot towel or a bottle of water.
However, as my client found out (just by chance, in asking an idle question), these 15 minute chair massages are being charged as complete sessions. So, in other words, if my client has 60 massages through her insurance, and she comes to see me for an hour massage, then her remaining number is 59. And if she then goes to get a chiropractic adjustment and agrees to get a 15 minute chair massage beforehand, she now has 58 massages in her “massage bank.”
What??? That made my head spin. How could an hour of massage therapy on the table and a 15 minute back rub equally count as “sessions?” Isn’t that like comparing apples to oranges? I couldn’t blame my client for being upset at having “lost” about 5 sessions to 75 minutes of chair massage when she could have had 300 minutes with me on the table.
Still, this didn’t sound right to me, so I went to the wonderful boss mentioned above and asked her to enlighten me. And she said something to the effect of: “Good question. Insurance pays for ‘up to 4 units per day.’ So no matter how many 15-minute units are billed for each date of service- 1, 2, 3, or 4, that’s going to count as a session. The concept that 1 massage = 1 hour comes from the massage world, not from the insurance or medical world.”
Wow. If this is correct, then I think an ethical question has arisen for chiropractors and other potential providers: Don’t you need to explain to the client that your 15 minute massage “counts” the same as an hour at a massage clinic as far as insurance is concerned? My client had 60 sessions of massage/physical therapy/chiropractic to “burn,” but most of us have only a dozen or so (if any). So this could be baaaaaaaaaaaaddd for someone who needed their massage and couldn’t pay for it out-of-pocket.
I’m in a quandry. I wonder if I should approach the chiropracter, as I really respect him and want to think he wouldn’t mislead anyone purposefully. On the other hand, I am making an apples and oranges argument, but still may not be grasping the situation correctly, which would mean, I guess, that I’m talking out of my cornucopia. Any thoughts out there?