Good the big guns out and fired first bullet. I saw Mr. Hammer (good name for lawyer) about taking action against massage therapist for her not willing to supply me with an itemized bill with codes to submit to insurance company for reimbursement. He is sending her a letter first to see if she will comply with this request. If not, I will have to take her to small claims court for 80% of $1435 is what insurance company would have paid me for. I cannot get reimbursement for lawyer/court costs. I also emailed AMTA of which she is a member stating that I believe disciplinary action is warranted in this case since she acted very nonprofessional and violated their Code of Ethics #7 "Accept responsibility to do no harm to the physical, mental and emotional being of self, clients, and associates." Hopefully I will get this matter resolved as it has certainly caused me undue anxiety. (TT)
I was sent email from staff liaison to the AMTA Commission on Grievances. I gave her information to call me in afternoon to file a grievance. In the meantime she asked me if I had contacted the regulatory board that licenses massage therapists/bodyworkers in Wisconsin. It is totally unbelievable but the massage therapist yesterday actually had the gall to send me an email with a story about me being such a friend. She is totally clueless about life. She had better fasten her seatbelt and get a refill on her Lexapro. (TT)
Sorry if I'm a bit confused on this one. I really don't see any ethical or regulatory violations.
I'm not sure I understand why the massage therapist has any obligation to supply this information to you. Was there some sort of verbal agreement or written contract made before or during the course of treatments to supply you with a coded bill?
Is it that she is unwilling or perhaps unable? Quite frankly, most massage therapists are poorly trained and do not know how to bill for insurance purposes. Very few do it at all. It's not part of their school program and they wouldn't know unless they took some more courses after school. In most states it's entirely optional for the health insurance company to pay massage therapists. Some require it, like Florida, or in some cases like auto or comp like Massachusetts, but most simply don't and won't because of so many disparities in training and regulation. Massage therapy has a long way to go to be accepted as a medical modality.
Prior to seeking treatment I had checked with insurance company and they paid for massage therapy. On initial visit she stated cash for each visit and I could submit receipts to insurance company for reimbursement. I totally agree that therapist was not knowledgable about preparation of paperwork for insurance reimbursement. However, I have no sympathy for her as this issue should have been cleared up immediately on 4/7 when I presented her with rejected forms. I stand behind insurance company because anybody can obtain a receipt book and write receipts. A professional would have admitted to her ignorance and perhaps we could have figured out a way together to get paperwork done correctly. However, she chose to string me along and finally agreed to try two different codes so I could get reimbursed and this is where she made her big mistake. You don't mess with a patient's money as it is like being robbed. When one advertises that they specialize in fibro patient's they should know something about condition and be aware that stress causes exacerbation of symptoms. She has been in business 8 years and I would think that she would have been presented with similar situation before. I know if I had a steady customer which could potentially last forever I would do everything in my power to get necessary paperwork completed. Her actions may well affect her having her license pulled or suspended and that will be up to Licensing Department to make that decision as today I sent complaint in against her. The funny thing is when I saw lawyer the first question he asked me "Is she even licensed?" I stated that she definitely was as I checked out her diploma on the wall. Should this be your money in jeopardy I am sure your feelings would be totally different. (TT)
I'm sorry, I guess I still just don't get it. Maybe because I wasn't there. You went to the initial visit. You found out that you had to pay cash and that had to file your own paperwork. Now you're upset because you had to pay cash and file your own paperwork. It seems like she did what she said she would do, which is to provide massage for cash.
I was in a bad auto accident. Part of my treatment was massage prescribed by the treating physician and paid for by the driver's insurance who caused the accident. I was very careful to call around all the massage therapists and ask if they took insurance cases. Most said no. I found one who did and spent some time on the phone to be absolutely sure she understood and agreed to be paid by the insurance company and to do all the paperwork herself and wait to be paid. I knew I couldn't pay and could not take the stress of dealing with the paperwork. Only then did I make an appointment. It took her six months but she got paid and did all the paperwork.
I just don't know why, if you were seeing someone on a cash basis and had to file the receipts yourself, and if the money was such an issue, why you didn't work out with the insurance company exactly what you needed to get reimbursed without rejection and then make sure you left each visit with that paperwork or stopped seeing her if you didn't get the paperwork. And why you went on to keep making appointments after not getting that paperwork on the second visit. I don't understand why you let things go so far, as the amount of money you're talking must be, what, 20 or 40 visits? This doesn't make sense. I don't get it why using the filing against the therapist is the answer because you didn't take responsibility for the paperwork when you knew from the first visit that it was your responsibility. I just think it's an abuse of the process to file against someone because of your feelings and that you're stressed.