Massage Therapy and Insurance Fraud2020-12-25T00:12:15-07:00

Massage therapy is a health care treatment that has the advantage of being included in extended benefit packages. In order to prevent abuse of this privilege, we have created a list of commonly asked questions and rules we must follow to stay compliant with insurance companies. Patients can sometimes be confused and offended when their Registered Massage Therapist refuses requests which might seem like a simple change but to do these changes is a request for the RMT to commit insurance fraud. The act of insurance fraud means that your RMT could lose their license so we will strictly adhere to these policies and rules.

Frequently Asked Questions
Your best friend is going through a hard time financially, she’s asked you to put through claims for massages that she didn’t receive and wants you to give her the money for those claims.2020-12-23T17:56:43-07:00

Regardless of the reasons, you cannot put through claims for treatments that you did not perform.

Since you’re an RMT and work in a spa, can you bill my facial as a massage treatment? I don’t use all my massage coverage anyway.2020-12-23T17:55:48-07:00

RMT’s can not misrepresent a treatment on a receipt. Even if the RMT is an esthetician, because this modality is outside of the scope of practice for massage therapy, they cannot bill for it under massage therapy. Refer to your member information and insurance page to see what modalities are covered by your insurance coverage.

My insurance requires a prescription, but I don’t have one. Can you put my claim through and I’ll get you a prescription later?2020-12-23T17:54:02-07:00

If you require a doctor’s prescription to access massage therapy benefits please note that prescriptions need to be issued before, or on the date of the massage for your insurance company to approve your claim.

I’d like to give you a tip. Can you add it to my massage amount and put it through my insurance?2020-12-23T17:53:15-07:00

Thank you for the compliment, insurance does not cover tips, and the best tip you could give an RMT is to refer a new client!

I won’t use all my insurance coverage this year. I have enough money left on my insurance for two more treatments. Can you put those through now and I’ll use up the money in the new year?2020-12-23T17:52:32-07:00

Pre-paid appointments are not billable to insurance companies. They will only accept receipts for treatments that have actually occurred. The date on the receipt needs to be the same date that the patient received a massage.

Since you also provide other services besides massage, can you bill that under massage therapy?2020-12-23T17:51:48-07:00

RMT’s can not misrepresent a treatment on a receipt. Even if the RMT has additional education in other therapies such as laser hair removal, because this modality is outside of the scope of practice for massage therapy, they cannot bill for it under massage therapy. Refer to your specific insurance policy to see what modalities are covered.

Can I charge an administrative fee for direct billing and include this in my fee for service? Example if a client pays cash their massage is $75 for an hour, but if I have to direct bill it is $80 for an hour.2020-12-23T17:49:49-07:00

Most insurance companies have policies in the place that prohibit charging fees for direct billing, review your provider agreement for details. Insurance companies view direct billing as a benefit/convenience for both their clients and RMT’s, direct billing can save clinics and RMT’s hundreds of dollars annually in debit/credit machine charges. It is also considered insurance abuse to have a separate billing schedule for those with insurance benefits.

Can you charge my insurance extra so that I don’t have to pay anything out of pocket? For example, you charge $70.00, the insurance covers 80%, but you bill the insurance company $87.51 so that the insurance company pays out the full $70.00?2020-12-23T17:48:52-07:00

No. You cannot overcharge the insurance company. Rates should be posted in your clinic and as a part of an ethical practice a massage therapist should charge the posted rate. It is considered insurance abuse to have a separate billing schedule for those with insurance benefits.

Sorry I missed my last appointment. Can you just bill my insurance company for it?2020-12-23T17:48:00-07:00

Insurance companies will not pay for missed or cancelled appointments. Trying to do so would be fraud.

I want to buy a gift certificate, but I want the receipt to say I purchased a massage, not a gift certificate, that way I can claim it on my insurance and get reimbursed.2020-12-23T17:45:50-07:00

Receipts are required to accurately reflect what was purchased (in this case a gift certificate or gift card). Insurance coverage does not cover gift card purchases.

My husband/son/daughter never use their insurance coverage. Can I get a receipt in their name so I can claim it under their coverage?2020-12-23T17:44:11-07:00

Receipts need to be issued in the patient’s name. Making a claim under someone else’s coverage, even if they are on the same insurance plan as you, is fraud.

Yesterday was the last day my insurance was valid, can you backdate the receipt?2020-12-23T17:43:28-07:00

Receipts can’t be altered in any way and must reflect the date that the service was rendered.

Take some time. Treat yourself. You deserve it.

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