It always starts somewhere in a social media thread. Someone brings up the all too common practice of therapists charging more for massage billed to personal injury claims than for their self-pay clients. Everyone seems to think it's totally legit. It's all about "how you word your policy" or some such excuse. In this article, I want to explain why I feel compelled to urge all my colleagues to stop this practice of overcharging massage for no-fault personal injury claims immediately. Seriously.
I'll preface this with, "I am not a lawyer." One thing I know about law is that it's open to interpretation. So you may disagree with my interpretation and conclusion, but I hope to convince you of the ethical rationale for therapists to STOP overcharging PIP claims once and for all.
Since specific laws about fees and charges vary from state to state, I will keep this as broad and general as possible.
What is overcharging?
You know that time when you were at a restaurant and you ordered the pasta risotto and the other table ordered the same dish, and they both came out just fine. And then you got your bill for $30 and you happened to overhear that they go their bill for $15.
And then you angrily asked the manager, "Why am I paying twice as much?!" And the manager said, "Well, you see this is our policy. Even though you both had the same dish, theirs was a wellness pasta risotto, and yours was a therapeutic pasta risotto. It's not a discernible difference in the risotto itself, but in the chef's intention. Also, we had to do a lot more paperwork to get you your pasta. And we took your credit card which means we won't get our money right away, and we'll even have to pay processing fees. So, you understand, right?"
No, because that NEVER happened! But just for your reference, that's what massage therapists are doing. Just with massage instead of pasta.
Fact #1 - Therapists are forgetting about "usual and customary charges."
According to Healthcare.gov, "usual, customary and reasonable" (UCR) charges are:
The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.
If your normal charge for massage therapy is $100/hour, isn't it unusual and unreasonable to charge that same client $180 for the same amount of time for the same service when they suddenly have a PIP claim? Remember, you're not just charging this to some big, faceless money machine. Your client's PIP money is finite. What if they need an MRI or surgery and can't afford it because they're out of benefits because their massage therapist decided to charge more?
To be ethical decision makers we have to consider the consequences our actions can have on others.
Some therapists have looked at the cap set by their state's insurance commissioner, which might be upwards of $200/hour for massage. Seeing that cap, they've determined to charge their clients with PIP claims as much as they possibly can. However, their local market only supports a maximum self-pay fee of $80/hour. So they figure out a "tricky" way to charge each based on what they will pay.
Fact #2 - You can't set up dual fee schedules.
According to Dr. Ray Foxworth,
Dual fees schedules—charging more to insurance companies than you do to your cash patients—and improper time of service discounts (reductions that are really more than a reasonable bookkeeping reduction), are illegal in most states. Offering discounts that do not fall into one of Medicare’s safe harbors is absolutely a violation of federal regulations in every state.
A reasonable discount like 20% for the reduced workload of not having to do the extra paperwork for insurance or hire a billing specialist is far different than the $100/hour "discount" that I see massage therapists routinely offering self-pay clients. Which says to me, this is NOT a discount. These are separate fees. One charge for insurance (PIP) claims, and another charge for clients who pay out of pocket. Because if you're charging $170/hour for massage billed to insurance and $70 to your cash clientele and calling it a "discount" ... well I'm not buying it.
#3 Just because you're not likely to "get caught" doesn't mean it's okay to do something. #checkyourethics
So far, all of the therapists I've challenged on this point have been unwilling to consider changing their overcharging practices. :-( Not because they entirely disagree with these points, but because they don't think they'll get caught.
Now that's an ethical kick in the rear. I can't disagree entirely that there is an appeal there. All the cool kids are doing it! But nah, I'm a grown up, and I make decisions based on what's right, not what's easy. Based on "do no harm."Oh yeah, remember that?
Overcharging is hurting someone. Namely, our clients. Also, it hurts us. We've all heard stories from therapists who got called out on their overcharging practices when an insurance company automatically reduced their bill. And of course, we all remember what happened in Florida. (Dark times, people. Dark times.)
What I'm really saying is...
Let's get real about overcharging no-fault insurance claims. If we want to offer administrative discounts to self- / same day payers, then let's make sure those are discounts on our standard rates. Let's hold ourselves to a higher ethical standard when it comes to setting our prices. Let's remember who we are and why we became massage therapists in the first place.