Q: Why can’t I find any massage therapists in Hawaii who take No Fault or Workmans Comp?

Q: Why can’t I find any massage therapists in Hawaii who take No Fault or Workmans Comp?

Tuesday, September 7th, 2010 at 3:55 am



Q:

I had an accident at work that involved someone else so I have 2 approved claims and prescriptions to get massage for workman’s comp and no fault claim 3 times a week 2o massages each prescription.  I figured I would have no problems finding someone to take one or the other.  However, everyone I called all said they used to take it but don’t anymore and now only offer reimbursements.  I don’t have the money to pay for 3 massages a week but I really need them.  Why can’t I find anyone?

A:

“There are a few therapists in Hawaii who still take workman’s comp (depending on what Island) but you are right.  More and more have stopped taking it including our clinic.  The reason is because Insurance company stall and delay tactics were so bad the  therapists were going months without getting paid.    I personally done insurance billing in Hawaii and I can attest to the blatant tactics used to prevent or stall payments.  I understand this is frustrating and we are in the process of teaming up with more than 15 massage businesses including some schools, and letters from 6 clients to file a complaint about it.  But the bottom line is that it is you the insured who has more power.  You are entitled to received covered therapy as prescribed by your doctor, by qualified providers.  If your therapist is not being paid timely, or your therapist is forced to stop taking you, complain immediately to your insurance company and the Hawaii Insurance Division.  We hope that they will get involved and help the therapists get paid timely so that they will start accepting no fault and workman’s comp clients again.”

Here is some information for clients and massage therapists for those who are affected by these insurance companies.

Hawaii does fall under the PROMPT PAY law which says they have to pay “clean claims,” or claims submitted to them without any missing or wrong information within 30 days or pay 15% interest and face fines from the Hawaii Insurance Division .   They are also required to respond to all correspondence in 15 days.  This is an accordance to Hawaii Statute 431.13.103.  The problem is, the insurers create a maze of payment-submission rules that guarantee there will be many “technical” denials for missing information or failure to follow the convoluted claims-submission procedures.

Keep in mind the above applies to no-fault.  When dealing with Workman’s comp the rules are a little different.   They use Chapter 386 which uses the Medical Fee Schedule specific to workman’s comp claims.  But they also still use the  Hawaii  Statute 431.13.103 which applies to the insurance company.  So which set of laws would apply would depend on which department was involved.    There is NO getting around the Hawaii Statutes in regards to how insurance companies are required to handle and respond as an insurance company.   The Hawaii Insurance Division is in charge of this and they monitor how the claim is handled irregardless of what type of claim because they enforce the rules that apply to licensing.

With workman’s comp claims they are required to pay in 60 days or let you know why they aren’t paying in writing CLEARLY indicating any issues after receiving first notification of services. They still have to respond in 15 days to any and all correspondence.

Why do insurers drag their feet on paying claims?

Premium money is invested in interest-bearing accounts.  An insurer delays remittance until the interest in these accounts is sufficient to pay the accumulated claims without cutting into the insurer’s profit margin.  Medical ethicists say “growing” the money isn’t a questionable business practice, but the deliberate denial and/or slow payment of claims is.   The problem is widespread.   Last year, Texas Insurance Commissioner Jose Montemayor slapped 17 health insurers with fines totaling $9.2 million for violating the state’s prompt-pay law and lawsuits have been filed across the country by providers charging slow payment of claims.

How Insurance Companies Manipulate the System

The insurance company is required to pay in 30 days.  Often they will claim to not get the documentation or say it is missing information.  There is no way to prove what they got unless you fax it or send it to them by email .  Then They wait as long as they possibly can to tell you there is a problem if at all.

Another issues is they say the auditor is taking a while to get the bill back.   If they make a mistake they will apologize and say they are resubmitting and escalating the bill but in most cases the process just starts over.  Most are just relieved the claim is going to be paid and think it is ok they have to wait longer.  According to the Hawaii Insurance Division, it doesn’t matter what happens they are required to pay or respond in 30 days.

Personal experiences

I have talked to 15 different massage businesses and here is some various stories about the most common complaints:

Intentionally giving you wrong information:

“When getting ready to send in claims, we call them first and ask them specifically how they need their claims.  The companies conveniently leave out something so that  our claim will be denied.  For instance, they tell you that you to just send in your invoice and soap notes with the CPT code, claim number and name of insured.  Then send it back because the therapist didn’t sign the invoice which is their “new rule”.”

When they can’t find something wrong with it, they will create it or make it up.

“I personally have seen companies actually alter documents or lie.  Example was recently we received a denial because they claimed the CPT code and Claim number was not on the invoice.  I had a copy of the fax where I could clearly see it.  I asked them to send the documents they had back with the official denial.  When I got to the last page of the invoice where the information was, they had physically CUT the page in half removing the lower half of the invoice.  The most common report was that the insurance companies claim pages are missing or they never received the claim at all even when you can prove it.  OR they will send it back saying something was missing that isn’t then apologize for the mistake and offer to reprocess it. Unfortunately everytime they reprocess it they claim it takes 4-6 weeks.”

“The best example of this was when a company sent us back the claim denying it because the provider is not clear.  The funny thing about that is the letter was made out and addressed to us, the provider.  If it wasn’t clear, how did they find us?”

Retaliation:

“Complaining or threatening to complain makes things worse.  They will just stop responding to you all together.  Ever since I told them I was working with other therapists to file a complaint, we can’t even get them to call us back.  When the guy finally called me back after I contacted his supervisor, he was hostile and rude.”

Refusing to give you information that will help you:

“I have attempted several times to ask insurance companies for information to help me submit claims.  Once I got Sedgewick to give me a template of how I should fill out the claim and was promised I would not be denied if I did it that way.  It was funny because I have since had the last 2 claims denied because the document they gave us had the information at the end and they seem to always LOSE the back page.”

“Progressive uses a company called  IMS in Honolulu.  They are contracted by Progressive to audit their claims.  After this company kept sending back the claim for something that didn’t exist, I finally had to complain.  After months of dealing with that mistake I didn’t want to go through it again so I called IMS to find out how the process worked.  I talked to someone named Robyn to ask her what IMS does and why they audit claims for Progressive.  I explained I was simply trying to understand the relationship and procedures so I know how to prevent further delays.  Robyn completely avoided answering my question and kept trying to refer to the claim, telling me they had fixed the issue with my claim and couldn’t understand what my question was.  I must have told her 4 times I was not calling about the claim, I just wanted to know who they were and why Progressive sends their claims there for auditing.  After several awkward silences and pretending not to hear my she told me I had to talk to her supervisor who did the same thing.  SO I called Progressive directly.  When I asked my question the rep already knew who I was and said that the claim was being processed and that she could not answer my question because she didn’t deal with Hawaii Claims.  I insisted that she had to at least know who IMS was and why they audit claims.  Finally she told me that they had a contract with them and they don’t have a choice but that is all she could say and said have a nice day and hung up.”

Law and where to complain:

HawaiiChapter 431:13

Reimbursement for Health Insurance Benefits

Clean, paper claims must be paid in 30 days,

electronic claims within 15 days.

Interest accrues at 15%.

Commissioner may impose fines.

write a letter to the Insurance Commissioner’s office, explain the issue, give as much details and proof as possible. Send the letter to:

PO Box 3614

Honolulu, HI 96811

or call 586-2790 (ask for an invesitigator)

 

Leave a Comment

9 Responses to “Q: Why can’t I find any massage therapists in Hawaii who take No Fault or Workmans Comp?”

  1. Gail McClary says:

    I have a small wellness center on Maui and accept No Fault & Work Comp cases. A couple of years ago, I had several of them and because of them made it through what would have otherwise been a very bad year financially.

    My personal experience with insurance companies has been very different from the person who answered the question. The adjusters I dealt with were always very helpful, I called them often and asked lots of questions. I was always paid in a timely manner.

    I currently have a therapist renting a treatment room from me and she is building her business on Work Comp and No Fault. I’ll see how her experience with the insurance companies is soon.

    My problem is, no more referrals for No Fault or Work Comp are coming my way. I wish they were! The pay is great. Sure there is a wait but it’s worth the wait. Once you get going on it, you can time how you send in paperwork and receive your checks in the mail pretty regularly.

  2. Anna Pang says:

    I would be interested in participating in any complaints you file. I am actually a physical therapist and I have trouble as well. I have been doing this 3 years and somehow this last year has been much worse. And then I got into an accident and am now on the other end of it. I have been having trouble with USAA getting my claims reimbursed. I will send you an email with my information. Thanks for the post!

  3. Hi Gail,

    Your right, the pay is great and the clients are great too. A couple of years ago it wasn’t this bad and it kept us going when things were really tight. We used to get paid very regularly. Yeah it was more paperwork and you had to wait a month but that was acceptable. But things took a turn for the worse at the beginning of this year. A doctor told me Obama made some changes that is making it very hard for anyone billing insurance companies. I am meeting with him next week to get details on what that was and will post it here. There is definitely a notable difference for sure. Two of our clients had to actually get attorneys. That is the first time I have seen that.

    Another thing we noticed is that insurance adjusters are getting fired left and right and replaced with people who are less responsive and less friendly. That makes it hard for those of us who established relationships with some of these people. There have also been many changes with the auditing of the bills. Some of the insurance companies have been outsourcing. So that slows things considerably.

    My advice to the therapist renting your room is to take lots of notes and get names of who you talk to and get as much as you can in writing. I don’t know what is going on but it is pretty bad right now. Why else would massage therapists choose to turn away over 40% of their clientele? There is something wrong when more than 85% of the businesses that used to take insurance aren’t anymore. Not only is that said for the therapists who I know could use the money, but its even sadder for the clients who have nowhere to go!

    Best of luck, and I hope she doesn’t have the same issues we have. If so, refer her here to share her story and maybe some of what is posted here will help! :)

  4. Jenni says:

    Yeah the minute you complain, your can expect to never get your claims processed properly if at all. This is why I no longer take insurance. I tried to complain to a manager because of the problems I had including my check being sent (and cashed) by the wrong provider and the claim girl I guess got fired for it and the new guy was a complete jerk to me after that. I gave up after 6 months on a $400 bill and finally billed the client. She got mad and left me negative reviews so I lost a client because of it. I realized it isn’t worth the trouble. I wish you luck and hope you can get some results but no one cares about massage therapists. They make too much money delaying payements. I doubt the Hawaii Insurance Division will be of any help.

  5. Nykol says:

    Aloha,
    We take no-fault and workmans comp. Yes they are difficult to deal with but we don’t mind. oceanfrontmassage.com

  6. Patrick says:

    I sometimes take no fault clients depending on what company it is. Some companies are better than others. I don’t take workman’s comp because if you don’t get paid you are not allowed by law, to go after the client for the bill. And the process to fight for the money is ridiculous. At least with no fault you can get them to pay the bill if their insurance company doesn’t.
    Insurance companies are notoriously bad at paying claims, this is a well known fact. And anyone here saying they haven’t had issues hasn’t been doing it long enough or frequently enough to feel the affects. Or they have someone else doing their billing.

  7. Ximena A says:

    I see the different point of views. Not getting payed is not acceptable but as a therapist my favorite type of work is on those who truly need it. I am willing to take the chance w/ insurance cases and am available for any refferals from doctors. Feel free to contact me. Ximena in Oahu

  8. Patricia says:

    At AromaStone, we have a therapist that takes 90% Auto and Workman’s Comp clients. She has had a positive experience with getting paid from the insurance companies. Billing is a very detailed process, no room for imperfections. I also have taken Auto Accident, Slip and Falls and Workman’s comp clients and have never had a problem getting paid. When I first started taking the insurance clients, yes, I did have someone else do my billing. It was definitely worth the money I paid her too. After a while, I figured it out and did my own.

  9. Julia says:

    I have been doing massage 22 years and now I teach. I stopped taking workman’s comp or no fault after 10 years too. For those who are saying they have no issues or don’t mind, you will. Just wait. Every client brings a different insurance company. You my have the few you have worked with so far that have been great but that always wont be the case. I went years with no issues and then in I got 4 clients that were coming in 3-5 days a week during a particularly slow time which was nice. When the insurance companies started delaying. It was over $5000 a month and it took my nearly 4 months to collect for each claim. Meanwhile I would continue treating the clients because I felt bad. After that experience I was very selective who I worked with. There were only 4 companies I would accept. So if you are careful and only work with the companies you know, you will be fine.

    But Helooo being willing to put up with this just because you want to help people is not helping anyone especially not yourself! You need to be paid for your services and insurance companies need to be exposed for this bad behavior. That way massage therapists will start dealing with them again and clients can enjoy more selections in care not have to feel bad because their therapists are not being paid.

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