ADVOCATE FOR MASSAGE THERAPY AS A RECOGNIZED & RESPECTED HEALTHCARE PROFESSION
By Elizabeth Jane Brooks, LMT, BCTMB and Dagmar Growe, LMT
We at WSMTA hear many complaints from massage therapists regarding how difficult it is to make enough money to support themselves and their families through massage. As seasoned massage therapists, we would like to pass along some advice which we hope you will find helpful.
With massage there are basically two paths to earning money, working for someone else or working for yourself. Another way to look at it is, there’s the easier way and the harder way. Let’s examine the two paths.
The Two Paths
When we first graduate from massage school we have some knowledge but we are inexperienced. A great way to gain experience is to work for someone else, such as a clinic or a spa. They can send you a steady stream of patients, helping you to gain experience. This usually comes at the cost of low pay (anywhere from $15 to $40 per massage). Therapists that stay working in this type of arrangement tend to overwork trying to make ends meet. Many therapists become burned out or injured, and end up leaving the profession.
If the newly graduated massage therapist decides to work for themself, the struggle is in getting a steady stream of patients. However, if they are able to gain a few good sources for referrals to their practice, the income will be much higher than what is received if working for someone else. This, too, comes with the cost of having to learn all the behind-the-scenes work like setting up a business, advertising, purchasing, billing, taxes, etc., all at once and often in isolation.
For most therapists, working for someone else is easier at first, but in the long run it is more strenuous and less financially rewarding. While working for yourself requires an investment of time and energy that is not necessarily immediately rewarded, it eventually offers more freedom, flexibility, and income.
A good suggestion for someone just starting out would be to work for a clinic for 1 to 2 years and then branch out on your own after gaining some experience, because the best way to make a lot of money with massage is by working for yourself. It is not hard to learn how to manage your business but it does take time and steady devotion. Therapists who are willing to do their own scheduling and billing can operate a business at very low cost which means a high profit margin per massage. It does require a certain amount of entrepreneurial spirit and the willingness to manage fluctuating income. Paying for the training you need from those that have successfully created a busy practice, and investing in building one's skills to set oneself apart from the competition, are well worth the money. You will save steps and time, and make even more money than those trying to reinvent the wheel by learning everything on their own.
However, therapists who do not want to work for themselves do have options for increasing their income. Here are some examples:
Branch out and start your own practice part time.
Remain working for your employer and negotiate a raise for your work.
Get a job working at a high end spa, which normally pays better, plus, the tips are usually quite generous.
Charge for extras, like hot stones, arnica application, aromatherapy, herbal packs, etc., and negotiate with your employer that the income generated goes to you not the employer.
Where it All Leads
It is interesting to note that the entire field of massage therapy over the last 20 or so years has shifted from predominantly self-employment or independent contractors to employment. Some of this has been driven by legal changes, specifically enforcement of labor laws regarding independent contractor status. The medical field in general has seen a move towards larger clinics with employed providers - there are hardly any independent doctors or other providers left. What sets us apart from most of the medical field is the fact that our patients are more likely willing to pay out of pocket for our services. In addition, we do not need lots of staff and office space.
However, if less of us are willing to take the risk of independence, if less of us are willing to fight for our profession, to engage and be involved with making the rules that determine our scope of practice and our rights to practice, if more and more of us are happy to let someone else handle these things for us - we may find one day that we will no longer have the opportunity to work on our own. Earning a good living with massage therapy may have become a thing of the past.
We hope this sparks a few ideas to explore and ends with you making the money needed to more than survive, but to actually thrive.
The Washington State Massage Therapy Association (WSMTA) is conducting a Medical Insurance Survey to determine if they are maintaining an accurate provider directory of contracted, active licensed massage therapists in our state. This directory must be updated monthly and certified with the OIC that it is current and accurate in accordance with WA state law. This directory is also the foundation to know if there are enough credentialed massage therapists with current, signed contracts in each region of our state with each medical insurer.
With the input of the Office of the Insurance Commissioner (OIC), the WSMTA is going to conduct a survey in November to check the accuracy of these directories. We need volunteers to help. There will be a brief training the first week of November via Zoom, volunteers will be given the entire month of November and part of December to call as many practitioners listed in the directories as they are able and they will document the accuracy of the information. The more volunteers we have, the more practitioners we can call, the more regions we can cover and a more accurate accounting will be gained. You will not need to travel to volunteer. Training will be done via Zoom. You will need a phone, computer and internet connection to participate in the project. Calls can be made in your free time. The project has a hard deadline in mid-December when your time will no longer be needed. You do not need to be a massage therapist to volunteer. If you know of anyone that may be interested in helping – clients, friends of massage therapy, retired parents, they are welcome as well.
To volunteer or for more information, please contact Julie Johnson at jjohnson@myWSMTA.org with the subject “Volunteer for WSMTA Insurance Audit”.
If you are unable to volunteer for this project, you can still be an active participant in our efforts with medical insurance companies.
- Make sure your information in the Provider Directories is accurate and get it updated if necessary.
- Canceling your contract? This must be in writing and tell them WHY. If you do not cancel in writing, you are still considered a contracted provider.
- Unhappy with your agreement, communicate and negotiate. Assume they need YOU. Don’t give up!
- Unhappy Clients/Patients, tell them why you’ve stopped accepting the insurance or are no longer accepting new patients. Encourage them to contact their insurer. If they are experiencing a delay in their care or are unable to find a practitioner in their area, they should contact the OIC. The OIC is there to advocate for the insurance consumer - not the practitioner - not us. Until patients complain about their inability to get access to massage services, nothing will change. YOU need to explain this to them and ask them to act. They can also volunteer for our insurance survey. Have them contact Julie Johnson at jjohnson@myWSMTA.org. .
- Go forth and share this with all WA Massage Therapists!
Jane Brooks wrote an excellent article on Insurance Network Adequacy which inspired this insurance survey effort.
By Robbin Blake
Currently, Monkey Pox (MPV) is in the news and WSMTA has received quite a few questions about it. The Washington State Department of Health (DOH) has a website page that provides very thorough information about the virus – you can see pictures of what it looks like, read about how and where it is spread and what to do if you are exposed. Fortunately, the virus has very defining characteristics and is mostly transmitted with direct contact. From the information on the DOH website you can create intake questions if you feel that you have the possibility to be exposed. If you feel that the person on your massage table may have MPV then do exercise your pathogen protocols that you have in place for handling linens the person came into contact with, disinfecting equipment in the room and washing your hands and forearms. As we are required to wear masks during massage still at this point, this protects against the smaller possibility of airborne transmission.
For details about the monkey pox virus, please see the following websites:
By: The Olympian
We highly recommend this article summarizing the Public Employees Benefits Board meeting and their decision not to terminate Uniform Medical Retiree plan, (which is currently administered by Regence BlueShield).
It's an excellent illustration and inspiration of how collaboration and forging alliances between advocacy groups, patients, providers and other stakeholders can work.
Stay tuned as CPP plans to consult with Laurie Weidner, executive director for the Retired Public Employees Council (RPEC) on strategies to forge such alliances.
Please click on the link below to read or to listen to an audio version.
WA retirees protest when PEBB tried to take away health benefits | The Olympian
Weidner explained that the process required a lot of public engagement with the issue before the board committed to the resolution last week to postpone a decision on UMP until Jan. 1, 2024.
WA retirees protest when PEBB tried to take away health benefits | The Olympian
Weidner explained that the process required a lot of public engagement with the issue before the board committed to the resolution last week to postpone a decision on UMP until Jan. 1, 2024.
by Elizabeth Jane Brooks, LMT, BCTMB
Last month, WSMTA asked our members if they were turning away insurance patients. In response, 20% said no (with some saying they would like more) while 73% said yes. Of those who said yes, 33% said they terminated some or all of their insurance contracts. These results lead to a recent board discussion on network adequacy and how some therapists have unfounded concerns over not taking new patients.
To begin, what exactly is network adequacy?
In order for an insurer to deliver their members medical benefits, they are required by law to supply a geographic area with an adequate number of in-network providers capable of providing those services in a timely manner. To do this, they create provider panels: listed as directories of contracted providers. If an insurer can show that it has an adequate supply of providers, it will close their provider panel and no longer issue new provider contracts. Because of this, it is important to let the insurer know when you are not accepting new patients. If medical providers inaccurately report that they are accepting new patients, the insurer cannot accurately determine if there is a need for additional providers.
When there is network inadequacy, it’s common to hear patients complain about how long it takes to get an appointment with their healthcare providers—and we’re hearing this more and more. With the proliferation of narrowing health insurance networks, it is vitally important for us to be part of the solution.
Some participating providers are concerned that if they report being closed to new patients it will negatively affect them and their contracts. To be sure, this is not just an issue for massage therapists, but for all healthcare providers. However, this concern is unfounded. Reporting that you are not currently accepting new patients will not harm your contract or reflect poorly on you. Instead, it will have the opposite effect: it will show that you and your services are in demand.
Faulty information impairs the entire system. In order for insurers to provide their members with the required number of providers, it is imperative that they have accurate information so that they can properly determine their adequacy. Accurate reporting and frequent status verification, therefore, is a best practice that helps insurers both credential a sufficient number of providers for their members and allows newer practitioners to become contracted. It helps everyone.
With all the issues facing insurance in our industry, accurately reporting our status is one critical way we can both encourage and reward good insurance practice.
Upcoming Event: Register Today
Please join us for the 2022 WSMTA Annual Meeting, including continuing education!
This year we have chosen to meet once again via Zoom. We have realized that this format has allowed us to reach LMTs well beyond the greater Seattle/I-5 corridor areas, so we are continuing in an online format.
This year's theme is:
Empowering LMT's and Clinic Owners in an Insurance Dominated Environment.
We have a lineup of three very knowledgeable presenters. Here are the logistics of the Annual Meeting:
Day: Sunday, June 26, 2022
Time: 9:30 am - 2:30pm PDT
CE Hours: 4 hours
John Conniff, Attorney:
John Conniff combines his broad background and practical knowledge to help clients find workable solutions to difficult problems. For over 25 years, he has counseled individuals, businesses, professionals, legislators, and government officials. In addition to running a law firm, John is a serial entrepreneur. He has owned or co-owned small businesses including Healthy Patients | Healthy Lives, providing business services to small health care practices and a multi-media company – JJP Media.
His wide range of experience provides him with insight into the complicated connections between business and law. He has worked extensively on employer issues, business contracting, insurance regulation, information privacy and security, health care regulatory
compliance, ERISA, and business transactions. John is a local attorney who has a decades long history with healthcare law and massage. He will be presenting on the topics of:
Competition law and healthcare networks
Antitrust and related business practices law
Supply and demand (with regards to massage)
Network adequacy and directory accuracy
B.J. Erkan, LMT:
While serving in the US military in 1990, B.J. hurt his back and experienced a musculoskeletal injury from the patient’s point of view. He was referred to a naturopath that had been previously trained in bodywork. Extremely skeptical at first, B.J. had a life changing, perspective shifting experience. Realizing he was meant for different things, he and his family moved to the Seattle area in 1991.
B.J. graduated from the Brian Utting School of Massage in 1994. Soon after being licensed, He had the opportunity to treat an MD with severe low back pain, and became known in the Kirkland area as a therapist who could effectively treat musculo-skeletal pain. In 1997 He began teaching massage anatomy and physiology at Bastyr University. In 1998 B.J. moved from Kirkland to Bothell and opened Bothell Integrated Health (BIH), LLC. Since then he and the BIH staff have given over 200,000 massages to people from Bothell and the surrounding areas. He also enjoys teaching CE classes to the BIH staff, and other therapists, and has taught, by request, at other medical massage clinics. BJ will be discussing:
History and economics of the massage business and how this relates to the formula of price setting and the importance of the collection of data of actual overhead costs in a variety of settings.
The downside of signing contracts for low pay and how that affects the entire profession.
The power of “collaboration and solidarity” amongst massage therapists, massage clinics, massage profession associations and other allied professional associations.
How to empower providers and our patients to create positive change in reimbursement rates.
Jane Brooks LMT:
Jane runs a private therapeutic massage practice dedicated to injury treatment and chronic pain relief. She is a board director with WSMTA, educator, writer, business consultant and the inventor of a patented seamless face cradle cover. As a seasoned therapist who has successfully navigated poor economic times, decreasing insurance rates, excessive demand for service, and Covid-19, she has a keen interest in helping others create their own sustainable and lucrative practice. Jane has been strategic in growing her practice to include multiple streams of income and moving from an insurance to a cash-based practice—all while charging premium prices, working fewer hours, and teaching others how to do the same. Jane will talk about:
How to increase revenue and stability with your insurance based practice.
How to transition from an insurance-based practice to a cash-based practice.
Ideas for potential additional financial streams and strategies.
Zoom attendance is 100 participants. We plan to record the meeting for later access and viewing.
WSMTA Raffle Prizes for June 2022 Anual Meeting.pdf
by Dagmar Growe LMT
There is an ice axe on the wall above the row of cash registers at my local REI store. A sign next to it explains the significance: A bunch of decades ago, some NW mountaineers decided to band together so they could negotiate better prices for their equipment – like ice axes. I wonder if any of the folks involved imagined their little co-op becoming the retail giant it is today!
It is stories like this that I want to keep in mind when dealing with situations as frustrating and overwhelming as massage therapists’ struggles in dealing with insurance companies. We have written in the past about the problem with “negotiating” collectively: US antitrust law which was created with the goal of protecting consumers against large and powerful companies, in a perverse twist of circumstance, is now protecting large and powerful companies against consumers (who can’t find a massage therapist to work with them) and small business owners.
And yet, just like those ice axe purchasers we can still marshal the power of the collective in a legal way. A great example is the collective purchase of legal services. Some Regence contracted LMTs had concerns about the latest contract that was sent out a few months ago by Regence. A respected and highly experienced healthcare attorney, John Conniff, provided the Washington State Massage Therapy Association (WSMTA) a legal review of the new Regence agreement We all know that legal services are expensive, and this lengthy contract and regulatory filings (228 pages) required many hours of work and resulted in a 13 page legal review that details the commitments that therapists enter into, the inconsistencies, and the conflicts with Washington statutes that exist in the contract. If WSMTA was charging hundreds of dollars in membership fees per year like other professional organizations (Chiropractors, PTs) we would gladly make the review available as a membership benefit. Given our current membership price, we have to handle legal reviews like the ice axe guys: Everyone pitches in and we all win. The review will be available to members for $100 – the cost of 1 massage (well, not an insurance massage) If you are not currently a WSMTA member you can go to our website, become a member for $40 and then be eligible to purchase the review for $100.. Your payment helps us to continue to provide services like this in the future.
Now, of course, you wonder: why would you want to know everything that is wrong with this contract, as you don’t have the power to negotiate a different contract with Regence’s non-existing provider service. We will share one bit we learned from the review upfront: The contract states that it is a confidential document. Not true, according to Mr. Conniff, healthcare contracts like this have to be filed with and approved by the Office of the Insurance Commissioner, and then are placed on their website, which makes them public information. This means we can legally talk about the contract. You also might want to know which parts of the contract are legally enforceable, and which are not! And then, depending on your circumstances, you can make an educated decision on whether to sign or not, or if you already signed, if you want to cancel or not.
This is but one example of how LMTs can exercise some power in a healthcare system that favors large companies. BJ Erkan, LMT and clinic owner will share more ideas at the upcoming WSMTA Annual Meeting on June 26. And the next time you go to your local REI store, look around:This is Power of Collaboration! Let’s make it our own power.
WSMTA Member Store Link
Navigate to the Store from the navigation bar. Store is only visible and accessible to members. Be sure to login to access the Store
Here at WSMTA, our goal is to promote and ensure the accessibility and financial viability of massage therapy as a reimbursed healthcare service and to provide resources to support practitioners. We have a strong desire to protect your interests and assist where we can.
Whenever we work with health insurance companies, use our computers for patients, work from our homes, or are injured on the job, there are some vulnerabilities that we’d like to bring to your attention—and their possible solutions.
Working with Health Insurance
In Washington State we are quite fortunate in being able to contract with health insurance companies. This is especially beneficial for our patients, as it can significantly reduce their out-of-pocket costs—and it is also great for massage therapists, as it may expand their practice and provide a steadier paycheck. For those early in their career, it can be of particular benefit: being in-network with an insurance company can bring many referrals, providing ample experience and filling your practice with new patients. Even experienced practitioners might use insurance as a stepping-stone, switching over to cash once they no longer need the referrals and demand allows for better pay.
However, working with insurance does have costs: lower rates, overworking, and post-payment audit risk.
To work with insurance, we must sign contracts accepting a reduced rate for our services in exchange for the many referrals that come from being one of their listed providers. These referrals are a definite benefit, but we are not able to enjoy this benefit to the same degree as a physician, nurse practitioner, or physical therapist who can see numerous patients in any given hour. In contrast, our work is physically taxing and takes at least one hour with the patient on the table—with additional time for the patient to get dressed, take payment, and rebook; extensive cleaning and disinfecting; resetting the room for the next patient; charting/report writing and billing. Several of our WSMTA members estimate that for every hour of work on the table there is often roughly one hour off the table.
Consequently, for many practitioners the major advantage of contracting with health insurance is how the referrals give us greater job security. As we gain experience we build up long waiting lists, and often end up unsustainably working nonstop for these lower reimbursement rates in an attempt to keep up with the demand. Fortunately, some of these patients will turn into cash clients when they have exhausted their benefits, or when coming in for a non-covered service (such as relaxation or maintenance massage).
When we contract with health insurance carriers, we agree to post-payment audits where the carrier can request chart notes and supporting documentation going back, on average, 1–2 years, and occasionally up to 10 years. During an audit, insurance auditors review your chart notes to see if everything charted matches with the referral and all necessary information is on it. Should the audit show any discrepancies or missing information, you are asked to retroactively repay the monies for the particular charts in error. If a massage therapist has been charting incorrectly in some way for years, the repayment for the incorrect charts can be so costly that the therapist’s practice may not survive.
Post-Payment Audit Insurance
This potential is the reason behind the search for post-payment audit insurance, also known as medical defense insurance. While common coverage for a physician, it has been difficult to find for massage therapists because we are relatively new to billing health insurance. Washington is one of the few states that allow us to bill health insurance companies, but as massage is increasingly recognized as effective healthcare, more states are positioned to join us, and more insurance companies are hopefully coming on board soon.
With so few companies providing this coverage, the quest has not been easy. The author of this article, for example, spent over a year communicating back and forth with different insurance companies trying to convince them to cover massage therapists. These included ABMP, AMTA, MMIP, Hands on Trade, and many more companies less known to massage therapists. She eventually found an excellent insurance agent, Christina Haranda at American West Insurance Agency (listed in the resources below). Christina went above and beyond in finding the coverage we need. She found MEDEFENSE coverage through Tokio Marine HCC, which is protection for healthcare professionals covering exposures—such as billing error proceedings through both government and private payers, as well as HIPAA and other regulatory proceedings.
MEDEFENSE coverage includes reimbursement of defense costs, fines, penalties, shadow audit expenses, including qui tam actions (filing false claims for funds from the government programs), HIPAA proceedings, EMTALA (Emergency Medical Treatment and Advanced Labor Act) proceedings, and STARK (self-referral and anti-kickback law) proceedings. Coverage limits go up to $1,000,000 each claim and a policy general aggregate up to $5,000,000. The minimum deductible is $1,000 and there is a minimum premium of $1,200 for a one year policy. Full prior acts coverage is also available.
In short, MEDEFENSE covers the defense of an audit, but not any monies due to be repaid to the insurance company due to fraud, errors, and/or omissions. This coverage includes a shadow audit—an audit where you hire an independent auditor to go over your charts, which can reduce the amount needed to repay an insurance company. It will also reimburse legal fees, fines, penalties and the previously mentioned proceedings. It is expensive for the average massage therapist; however, in the event you are wrongly accused of fraud, errors, or omissions and the insurance carrier is asking for $25,000–$100,000, it would be money well spent.
Another suggestion is to hire an independent auditor to review your charts before you are audited—it can be especially helpful if you can find an auditor experienced with massage coding and charting. To find an auditor, many have found it helpful to search local hospitals or large clinics.
Cyber Liability Insurance
Tokio Marine also offers cyber liability insurance coverage which can be bundled with MEDEFENSE or purchased separately. Cyber insurance covers your business liability in case of a data breach of sensitive patient information—this can be a breach of any files containing personal identity information, health and/or financial records. Additional items covered are legal expenses, negotiation and payment of ransomware demands, plus restoration of data. It should cover both your business and third parties (i.e. your patients). Some questions to ask yourself to determine your vulnerability are:
Do you email medical information?
Do you keep any patient medical information on your computer, tablet, or cell phone?
Do you keep any patient financial records on your computer, tablet, or cell phone?
If you answered yes to any of the above questions, cyber liability insurance is worth considering.
Homeowners & Renters Insurance
There are quite a few LMTs that work in their homes rather than in a business office space. Some insurance companies have a problem with this, as the lines between what is business and what is personal can become blurred, potentially increasing claims. In these situations, the insurance company is concerned with patients injured on the premises pursuing both our business liability insurance and our homeowners/renters insurance, and because of this it can be difficult to find coverage for these circumstances. Thankfully, the following insurance companies are favorable to those of us that work from home (sometimes through an additive “umbrella” policy): MetLife, Travelers, Country Financial, and in some cases Allstate.
Disability insurance can be difficult to find as a massage therapist because the injury rate is significant in our field. However, Crump Disability Solution Center has stated they have carriers that will cover massage therapists, including Assurity and Mutual of Omaha.
Should you be unable to work for a period of time due to illness or injury, most disability insurances pay between 50–70% of your pre-disability gross salary. For therapists with S-corporations, it will be important to check if their passthrough income can be included.
To be covered, most plans require a minimum of a 30-hour work week to qualify, which for massage therapists can be made up of such things as massage, cleanup, setup, billing, education, and purchasing supplies. With this minimum met, costs will depend on a variety of factors such as age, health, and income.
Some questions to ask yourself:
How long can I manage my monthly expenses without my paycheck?
Do I have personal savings or a retirement plan I can dip into if needed?
WSMTA is providing this information for you to consider for your protection and that of your business and patients, along with some possible resources. If you are aware of other resources, please send them to us at firstname.lastname@example.org.
Medical defense, cyber liability, homeowners/renters, and auto insurance:
American West Insurance Agency, Inc.
Tokio Marine MEDEFENSE Plus
Cyber liability insurance:
Travelers Cyber Insurance
RPS (Risk Placement Services)
Tokio Marine Group
Country Financial (homeowners)
Country Financial (renters)
Have you been receiving unsolicited emails from what looks like it could be a Regence email address? Is it real? Or, is this part of a cyber attack? Could it be both?
The answer to this question seems to depend on who you talk to at Regence and how far the representative is willing to dig into the question. Some providers who have called Regence Providers Relations and spoke with a representative have been told “Yes it’s real. The website says Regence is switching all individual provider agreements with a new, standardized Professional Services Agreement and must be in electronic format.” Other providers who have called Regence have spoken with representatives who have dug-in a little deeper, (beyond the first page of their website), and have been told they can not find anyone at Regence who will take responsibility for sending these emails out to providers.
So what do we do?
Cyber Security 101 tells us to never click on any links contained in unsolicited emails we may receive.
At the very least, here are some of the precautions a provider should take if receiving such emails:
Be cautious of any emails that use exclamations like “URGENT”, “MUST RESPOND”, or mention some sort of penalty if you don’t respond immediately. Typically, these emails are not from any legitimate source.
Be suspicious of any emails that have spelling or grammatical errors and dates that haven’t been updated to the current year.
Double check email addresses and make sure they match previous legitimate email correspondence. Look for slight misspellings and differences.
It is easy for malicious operators to download logos, contact information and text to look like the real thing.
If you are unsure, consider looking on your secure Availity portal to see if you have any alerts or messages.
Always go directly to the providers' website, contact information or secure portal to look for updates and current information.
Double check to see if your Regence provider contract is still current or due to expire.
Consider calling Regence Provider Relations before filling out any information online.
Regence is in the process of updating their contracts and moving renewals online. After ensuring any email communication from Regence is legitimate, here are a few things to consider with a new contract.
Read and compare your new contract to any previous contracts.
Is this the same contract or does it have changes other than moving to an electronic format?
Am I willing to take on the responsibility that this new contract requires of me and my business?
Have I checked with the OIC to see if this contract has been approved?
If I sign this new contract, could it still be binding even if the OIC has not approved it?
Should I have an attorney review the contract BEFORE I sign?
What are the ramifications if I don’t sign this new contract?
Do you have questions regarding this new contract? Please send your questions to us as soon as possible.
We have reached out to an attorney who specializes in reviewing provider contracts. Our goal is to have him thoroughly review & clarify the contract(PSA) language including any additions/changes from prior contracts and research approval by the OIC. (Office of the Insurance Commissioner)
Are you interested in helping share the costs and the results of this legal review/consultation. Please let us know along with any questions you may have.
By Dagmar Growe, LMT
In our quest to determine the rate we need to charge for our services versus simply charging what everyone else does, we have looked at the actual cost per massage, and our needed and desired income. The method we used to determine cost per massage can of course be applied to all other services we offer.
In this last segment we will put the numbers together and see how close we are to having a financially stable and successful business. We will also look at some additional considerations.
Your real hourly income:
Maybe you work in a setting where a 1 hour massage consists of 50 minutes, and you walk out of the office after your last massage with no further worry. Otherwise, it’s important to look at how much extra time you put in. Client calls, insurance billing, promotion, bookkeeping, business management all need to be compensated by your massage income. If you make house calls, this includes your driving time. If you have employees there is all the time you spend managing them. Keep track for a week or two of how much time you spend outside of actual massage time. Maybe you find that for every massage you provide you spend 1 ½ hours work-time, meaning you have to divide the net income per 1 hour massage by 1 ½ to determine your hourly income.
Self-employed vs. Employed:
Generally, employed therapists have less extra duties than self-employed therapists. However, requirements can vary greatly from one place of employment to the next. If you interview for a job be sure to ask about all the additional work you are expected to perform. Will you be paid per hour of shift time? Per massage? What happens when a client does not show up, or an appointment does not get filled? What benefits are offered? What are the rules when you decide to leave - will you be allowed to take your clients with you? What restrictions are placed on you by your employer?
Self-employed therapists generally have more freedom to set their own schedule. With that comes the extra work of managing one's own business. Think about which jobs are worth the expense of hiring out. Bookkeeping? Laundry? Insurance billing? This is not just a money question, but also one of skill, time constraints, and personal preference. If you really hate bookkeeping it might be worth the cost of a bookkeeping service - I prefer to do my own so I can stay on top of my business finances month-to-month. Also keep in mind that you will owe quarterly self-employment taxes, which are double the social security tax that an employee pays - the employer is responsible for the other ½. On the up side, for most self-employed therapists the biggest expense is office rent. As this is often a fixed cost, the cost per massage will decrease with more massages given. This makes it easier to increase one’s income if needed.
Insurance or Not:
Insurances claim that their lower reimbursement rates are made up for by the larger number of clients they provide to your business. This makes sense only if you cannot generate enough business without those referrals. You may be willing to fit insurance clients into your busy schedule to make massage therapy available to patients who could otherwise not afford it. But you also will need to look at your cost per massage, and in fact your hourly income per insurance massage as insurance work often requires significant extra time. You may find that the reimbursement rate does not cover your cost or leaves you with a ridiculously low hourly income.
All of these considerations play out differently in different phases of our lives. I started massage therapy when employment was rare. Initially I tried to build my own business, but found it difficult to generate enough clients. I switched as an independent contractor to a local massage business which provided me with lots of clients - great for a new LMT to “practice”. I then found a place of employment which provided me with health insurance for my growing family, and allowed me to take extended maternity leave without having to worry about my practice. Eventually, my relatively low hourly pay created financial hardship for my family, and when my employer discontinued offering massage I jumped at the opportunity to be self-employed. My income immediately increased significantly. I worked from home, which meant very low cost per massage (and allowed my kids to appreciate how hard their mom was working - not a bad lesson for children). After a few years of working on my own, I joined a local clinic part-time. I had not even realized how isolated I had become in my home office. Now that my children are on their own, I appreciate the opportunity to take off as much time as I want. I still work part-time at home because of the low cost, and part-time at a clinic because the interaction with peers is important for my quality of life. I am constantly decreasing my insurance availability because the reimbursement rates do not afford me the life choices I am making.
I hope these articles have been of help in looking at the facts of your business and considering the options you have. Like with my story, different options may be better than others at different times of your life. With the current shortage of LMTs this is an excellent time to carefully consider all the facts, and make continuous choices in the direction of your dreams.
There has been a lot of buzz around the increase of the maximum number of massage therapy treatments allowed through Uniform Medical Plan. Uniform Medical members are calling massage clinics and asking to schedule “their” bi-monthly massage. However, as is generally true, things aren’t as simple as they seem, especially when you read Uniform Medical’s fine print.
First of all, it’s important to note that this change only affects Uniform Medical, not any other plans administered by Regence. Uniform is a self-insured plan which means it can make up its own rules, including offering higher limits on allowed visits.
Second, according to the Uniform Medical Plan(UMP) Certificate of Coverage a prescription is still required. This means a physician’s order for a service (or a procedure) that is needed to treat a specific condition, specified by a diagnostic code. In other words, Uniform continues to require medical necessity in order to pay for treatments. If a future audit finds that massage services were not provided as treatment for the condition indicated by the prescription, the massage therapist might be faced with a demand to repay insurance payments received for those massage treatments.
Unfortunately, the benefits summary is not specific about any of this, physicians frequently provide very general prescriptions at patient’s requests, and massage therapists are left in the uncomfortable position of explaining to patients the unexpected limit of their benefit. Be sure to carefully and correctly document the treatment nature and medical rationale for any massage services you provide, especially for treatments that are reimbursed by health plans. Your treatment records are your best, and likely only defense if you are facing an audit.
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