The Insurance Game:

I know there is a lot of confusion around insurance. Can you can use your benefits? Are there discounts for paying at time of service, sliding scale, etc? This post is actually a lead up to a change I’m making – don’t worry I will still bill insurance, but I want to share with you many of the intricacies of insurance billing, why I was doing it this other way and why I’m changing things now.

Let me be frank. I don’t like billing insurance. I do it so I can work with a wider variety of people, but if I had the choice I would probably drop it all. Work life would be so much more simple. However, at this time in my practice the negatives don’t wholly out weigh the positives.


Many of us healthcare providers supposedly charge more for insurance. Well that’s not exactly the case. It’s more complicated than that. We bill what it costs us – usually. (Of course there are exceptions.)

The following is an example of the “game” that we healthcare providers all play if we bill on behalf of our clients:



Sally Whoever LMP works with insurance clients and non-insured clients. You may not know it but she charges $120 for a massage. Posted in her office are the cash-based-fees only.  In fact, you only become aware of  the differences when it showed up on your insurance explanation of benefits. The weird thing is the  service is broken down in several ways and doesn’t add up to $120 paid out. Insurance pays a portion and you pay a portion via copay for a total of $58.  However, that leaves unpaid and unexplained $62. You wonder why in the world she charges $120 for an hour massage when they only allow $58 to be paid out. Also why would she charge $120 if the cash service fee is only $65?

It all has to do with what you don’t see:

Insurance Billing Scenario

When you first called to ask about using insurance for massage, Sally confirmed your insurance benefits and then put you on her  schedule. She does this to protect both herself and you the client. That took 10 minutes, including a short hold time.

You come in for your massage which includes about 10 minutes of intake so she can take proper notes and figure out how best to treat you, followed by 60 minutes of table time. You pay your copay($30), reschedule, leave and go home to ice. “Check out time” takes about five minutes.

Later when she has time, Sally sits down to bill for your treatment. She first puts you into her billing system. She’s a sole proprietor and prefers to keep her overhead low so she uses a free clearing house. A clearing house is a company that allows access to online software for billing electronically. They can offer it for free because they get kick-backs from the insurance company. The insurance company gives out those kick-backs because it saves them money since they don’t have to pay someone to do the laboriously job of reading through hand-written HCFAs(bills).

It takes Sally 30 minutes to input you into her system. She has to follow specific protocol for how to input patients to save her time later.  Depending on the insurance company she can submit it electronically or she may have to print it off and mail it. Then she waits…

The next time you come she gets to skip some of the work because you are already in her system. She simply has to  create a visit, then a bill, and sends it off however it needs to go. Usually it’s quicker but it’s common for things to arise to eat up that “extra” time saved.

Two weeks to two months later she gets paid by the insurance company. She gets a $28  check. Your copay covered the other $30 allowed by the insurance company.

Sally spent the following time just on your first appointment and everything she had to do to get paid for that:

  • 10 minutes on the phone with insurance company
  • 75 minutes with you between intake and table time
  • 30 minutes for imput and first billing

Total time: 115 minutes(one hour and 50 minutes)

Total paid: $58

Non-Insurance  Scenario

Then consider the possibility that you are a non-insurance client.

Sally schedules you. You come in, fill out paperwork, have about 10 minutes of intake, 60 minutes table time and five minutes check out time. She charges you $65 for 75 minutes of time with you. No billing, no phone calls to insurance, no inputting of insurance info. No worries.

Total time: 75 minutes

Total paid: $65

The comparison:

Off each massage hourly she makes the following:

Insurance: $30.26/hr

Non-insurance: $52/hr

If you are confused you aren’t alone. The rules are that we are allowed to charge for how much is “costs” us hourly for the massage and other admin time(billing etc), whether or not we are paying ourselves or a billing and/or front desk person. In Sally’s case her time is worth $120 for almost two hours of work (some of that includes taxes). The thing  that gets forgotten by the client is the extra time spent behind the scenes. When I was a patient at a doctor’s office I didn’t understand it either. As health care consumers it’s never explained to us how much more work it actually takes to bill insurances.

Let me break it down a different way.

Sallie allows for $65 per massage. So for the 70-75 minutes spent with you she charges just under a dollar a minute. Fairly standard in the massage world – we are specialists and don’t exist on a normal 8 hour a day work day. Our bodies would fall apart much faster if we tried to do 8 hours of massage in a day.

Sally allots $55 for 45 minutes for billing and the other paperwork that comes with it. While this might sound like a lot you have to consider everything else that might happen:

  • The insurance benefits much be confirmed even if the client decides not to come in
  • Hold times happen – sometimes the billing person or self-employed therapist has to sit on hold which can draw out the time spent on a specific claim/date of service
  • Sometimes they have to check online (which is fine) but sometimes you have to call anyway because massage isn’t written into the plans basic documents.

Insurance is rarely easy to deal with and doesn’t pay well. Soooo, lots of massage therapists don’t take it.


Let me get back to the whole point of this post. I’m changing the way I do things to better protect myself because of the complications of the law. I’ll be covering that in another post, this one is just too long already. What you need to know is that across the board I will have one charge: $65 for massage that isn’t a specialty service  such as aromatherapy massage. It does not reflect all the work I do for my insurance clients. More transparency in healthcare is beneficial perhaps imperative, so I’m telling you guys what’s going on. Also, I’m just tired of playing a game that’s really just set up to fail me anyway. At the moment, this is the only way I can think of to do business that finally sets my mind at ease. I’ve always known that I don’t get paid for all the work billing insurance requires. Now you guys know. That’s all.


One Comment

Leave a Comment