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
Regardless of the reasons, you cannot put through claims for treatments that you did not perform.
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.
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.
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!
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.
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.
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.
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.
Insurance companies will not pay for missed or cancelled appointments. Trying to do so would be fraud.
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.
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.
Receipts can’t be altered in any way and must reflect the date that the service was rendered.
