Insurance is a tricky conversation, especially health insurance. It changes frequently enough that it can be challenging for most of us to keep up. I decided to put a little something together this month to help support you getting the most out of your healthcare experience; specifically, where you might be leaving money on the table (this may go beyond my services, too–keep reading).
We’re living longer, we take on more stress in our day-to-day lives, causing our minds & bodies to expand on a regular basis. Having a regular health plan is a must, and this does not have to be limited to what your insurance will cover or having just a yearly check-up with your GP.
To be clear, this article isn’t about going over your benefits; your coverage changes too often, and that’s beyond my skill set anyway. Instead, it’s to show you where you may have the opportunity to get money back through using your out-of-network benefits. This can happen through an itemized receipt called a Superbill, or by using your FSA & HSA cards (health savings account) to pay for services that aren’t directly covered by your main benefits. Most individuals who have a health savings account are aware of their benefits, because you actively sign up for them. So instead of spelling it all out, I’m only highlighting how to use a superbill.
Let’s break this down a bit
In a perfect world you would have full coverage, the choice to pick which provider you’d like to see, and have any services you choose covered. For some of you this may be the case, but the majority of us are limited by what our insurance benefits will cover. Insurance companies dictate how we care for ourselves and which individuals/businesses provide that coverage – unless you have the financial means to pay out-of-pocket (at their “cash” rate).
I can’t speak for everyone, but most healthcare providers like myself choose our profession because we want to be of service and support your health journey. We would love to have that covered by your insurance so you can focus on your well-being instead of, ‘how am I going to pay for this?’ Unfortunately, we don’t run the insurance companies; in reality, many healers are cash only because we fall to the bottom of the insurance payout food chain – it’s tough to get them to pay us. As a result, we have to walk the line between being of service and providing a sustainable life for ourselves and our families.
I accepted insurance for the first 10 out of 17 years I’ve been in practice. When I started, most insurances paid a livable reimbursement percent for providers. Now, I would be better off working at Starbucks where I would get health insurance, tuition reimbursement, and retirement benefits. This can also be why it’s so hard to find a massage therapist in-network – most of them know they will never be able to provide enough service to cover the average cost of living (mind you, I live in Seattle, and this may not be the case for other countries or states). Or, if they do take your insurance, they have no availability because all their clients book out a year in advance. Finding a massage therapist who takes insurance is like trying to find toilet paper at the beginning of the pandemic. Too soon to joke about, lol?
Luckily, there ARE still options – you can have a Superbill fly to the rescue! (well…sort of 🙂 ) A Superbill is a real thing, and though it can’t fly, you can use it to benefit your healthcare needs.
In short, a Superbill is a record of visits to a healthcare provider which a client (you) can submit to insurance companies to request reimbursement. Superbills have lots of detailed info similar to an insurance claim, like date of service, procedure codes, how much you paid for the service, etc. If you have been looking for a way to get your insurance to pay for your favorite massage therapist, it’s a great step to try.
There are a few things to consider before submitting a claim:
- Check with your insurance provider to see if you have out-of-network coverage. If you don’t, you may be paying for services you can’t afford and your insurance won’t reimburse you. I wouldn’t want anyone to get stuck in a sticky situation.
- If you do have out-of-network coverage, then ask your healthcare industry providers for a Superbill or Itemized receipt. (In Washington, massage therapists are part of the healthcare industry.) Depending on your plan’s policies, you might get these Superbills after each session, or on a monthly or quarterly basis. Meaning, some plans won’t pay for services rendered if they are over 90 days.
- If you do have coverage, I’ve seen plans cover up to 60-80% of the treatment amount.
- Another cool fact I’ve learned over the years: in some cases your plan might cover more than your in-network benefits–I know, shocking!
- All insurance plans are different and change yearly. Always call for clarification.
- And always write down the name of who you spoke to and the time & date you called. A lot of people on the other end might misquote you or provide incorrect feedback. It’s good to keep a record in case you ever need to file a complaint with their office.
- Last fun fact: Because the foundation of my practice is massage, I can also incorporate energy work and sound therapy, and you can still submit your insurance claim for reimbursement. Shhhh, we can’t brag about it; we want them to think it’s only a massage.
Steps on how to submit a Superbill for massage. (Please note: It bears repeating that every situation is unique. This process will look a little different for all of you, but I will try to give you a simple outline.)
- Go to your insurance provider’s website (you’ll need to to create an account, if you don’t have one already)
- Log in
- Once you’re logged in, click on the claims tab (most insurances have this on the top toolbar; if you don’t see it, do a quick search to find it)
- Print out their claims form
- Note that most insurances don’t require you to have a prescription for out-of-network coverage, so you don’t need to fill out or have the provider fill out the bottom half of your claim. There are a few rare cases your insurance does require this to be filled out (check with your insurance).
- And if you do need a referral or prescription this comes from an ND, GP, or Chiropractor…remember how I said I was at the bottom of the insurance food chain? Massage therapists can’t prescribe or diagnose, so this will need to come from someone who can.
- You’ll then take that claim form and your Itemized receipt (aka Superbill) and submit it as a claim through your insurance.
- This is usually through their messaging center or somewhere in the claims section of the website. You may have to dig; they don’t always make it easy to find.
- After you submit your claim you should hear from them or be paid out in two weeks. If that doesn’t happen, call them. Insurance companies can be a pain and some will find any reason not to pay out – advocate for yourself.
I unfortunately have no power in the insurance world, outside of being able to provide guidance on getting you a little money back in your pocket. The more we advocate for ourselves or complain about the corruption in the insurance world, the more voices we have in the pool for change.