Danielle DeLeonardo,LMT Good Life Massage, New Jersey
Licensed Massage Therapy. After Section 2706 went into effect (Jan 1, 2014)
I am trying to get reimbursed by health insurance for treating my clients. I have received prescriptions/referral from a few doctors to treat their patients.
- I am a registered provider with a large insurance company in the state
- I verified coverage and got authorization from the company to treat my clients with Therapeutic Massage
- I provided all documentation they asked for
- I filled out all forms to be a registered provider, gave my W9, Tax ID, State License, Group NPI and Individual NPI, taxonomy codes, a copy of section 2706 with question and answer
- I also provided a document from the State of NJ that clearly describes what is in the scope of practice of a Licensed Massage Therapist (LMT) in the state
- I also provided a list of approved modalities in NJ
- I registered for an automated claims system (NaviNet)
- I submitted my claims electronically and used the proper billing codes.
- I paid $790 for an insurance billing seminar
I submitted 10 claims. After going back and forth with the company for three months and patiently waiting for all documents to be processed, I was told today that one claim has been paid. Nine were denied due to the modalities not being in my scope of practice. I called and explained that the modalities used are not out of my scope of practice and sent over the document from NJ that clearly explains what is in the scope of practice of a licensed Massage Therapist.
I have been directed to appeal my claims. This will take another 30 business days, and even then, if it is denied again, I can submit another appeal, and that will take up to another 90 business days. Although I will go through the process of appeal I have no choice but to temporarily discontinue my client’s treatment. I feel terrible about this because my client is in pain and over the two months of treating him, his pain has lessened and is getting better.
I am asking for help. The truth is that the insurance companies here are trained to say No and deny claims, or delay them, or confuse people to discourage them from pursuing further. I very much want to change the healthcare system for the better. My mission is to make receiving therapeutic massage on a regular basis affordable for those who need it, and help my fellow hard working massage therapists be respected in the heath care community and be paid accordingly.
Submitted: Feb. 6, 2015
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