Insurance Massage: What Makes a Session a Session?

I just do insurance massages, I don't bill for them (thank the Gods). My wonderful boss is the one who walks the labyrinth on that one. So I was perplexed last week when a regular client came in feeling a touch irritated and betrayed about being billed for entire insurance sessions at the chiropractor's office.

This gets a bit complicated, so let me elaborate. I was the one who referred the client to this particular chiropractor in the first place, and she loves his adjustment. I see him as a client myself, and also appreciate him as a skilled and honest practitioner . . . of chiropractic medicine. Now, I knew he employed a massage therapist who did a short kind of "spot" massage or chair massage to loosen up the muscles before adjustment. But I've never gotten one of these massages myself--partly because I call short chair massage "tease massage"--and I guess I never thought about how they were being billed. Maybe I didn't even think they were being billed at all, just being offered as a nice extra, like a hot towel or a bottle of water.

However, as my client found out (just by chance, in asking an idle question), these 15 minute chair massages are being charged as complete sessions. So, in other words, if my client has 60 massages through her insurance, and she comes to see me for an hour massage, then her remaining number is 59. And if she then goes to get a chiropractic adjustment and agrees to get a 15 minute chair massage beforehand, she now has 58 massages in her "massage bank."

What??? That made my head spin. How could an hour of massage therapy on the table and a 15 minute back rub equally count as "sessions?" Isn't that like comparing apples to oranges? I couldn't blame my client for being upset at having "lost" about 5 sessions to 75 minutes of chair massage when she could have had 300 minutes with me on the table.

Still, this didn't sound right to me, so I went to the wonderful boss mentioned above and asked her to enlighten me. And she said something to the effect of: "Good question. Insurance pays for 'up to 4 units per day.' So no matter how many 15-minute units are billed for each date of service- 1, 2, 3, or 4, that's going to count as a session. The concept that 1 massage = 1 hour comes from the massage world, not from the insurance or medical world."

Wow. If this is correct, then I think an ethical question has arisen for chiropractors and other potential providers: Don't you need to explain to the client that your 15 minute massage "counts" the same as an hour at a massage clinic as far as insurance is concerned? My client had 60 sessions of massage/physical therapy/chiropractic to "burn," but most of us have only a dozen or so (if any). So this could be baaaaaaaaaaaaddd for someone who needed their massage and couldn't pay for it out-of-pocket.

I'm in a quandry. I wonder if I should approach the chiropracter, as I really respect him and want to think he wouldn't mislead anyone purposefully. On the other hand, I am making an apples and oranges argument, but still may not be grasping the situation correctly, which would mean, I guess, that I'm talking out of my cornucopia. Any thoughts out there?

Virusly Yours

I'm not one to whine - except in this space - and I have been floundering in computer virus hell for nearly a month. Cesar, the techie not the general, finally brought my computer back today and after some standard confusion, I'm at the keyboard again.

Which is to say I'm at a crossroads. I'd gotten used to just checking emails. I haven't looked at my facebook stuff in ages. The pictures from Uncle Augie's 90th birthday party are still in the camera. I haven’t updated this and that, and I seem to be just fine. I got my news from the paper, my funny jokes at the salon.

So why do we need these things anyway? My clients got to enjoy the unique experience of my business cards with hot pink strip across the top, a mistake that I cringed at when it happened. That sage green graphic summoning calm serenity was kind of boring, eh? The hot pink business cards, that I had to use when the regular ones were all gone, kind of shook things up a bit.

Plainly, these computer things are here to stay. I haven’t been able to do a bunch of things that I really love to do, and most importantly, being without a computer with the bells and whistles does affect your massage practice.

The database hasn’t been updated. My tips page needs new stuff. I haven’t sent the quickie, inexpensive emails I like to send to missing clients. A reminder card costs from 50 cents to a dollar to send. Emails cost less than half a penny.

Oh, and the blog. I wanted to share a few things that came up recently, and I’ve been feeling a bit stifled.

Guess we do need computers after all. Like the telephone, they can get annoying but we depend on them nonetheless.

P.S. If you get a warning box to activate your anti-virus software because of a bad, bad virus, just shut the machine down right away. It’s a phony warning that turns your hard drive into a planter.

A Watery Path

I was raised on Coca-Cola. Straight or on the rocks. Peanuts or sans peanuts. It was THE drink. Why would you want water when you could have a refreshing Coke that fizzed up your nose and made you say "ahhhhhh" with satisfaction? I can still remember putting fifteen cents in the machine, opening the door to a rush of cool air, and hearing the clinking sound of the glass bottle as it left the slot. Then, of course, the pop of the metal cap on the built-in bottle-opener. It was the South, it was hot, and Coke was heaven. I have to say, unashamed, that I miss those sounds, even though I haven't been a Coke drinker in over a decade.

I quit a long time ago, first to go to Diet Coke, because like all young women, I was dieting. In the bars, I'd have my bourbon with Diet Coke, because as my friend Anne used to say, bourbon and Diet Coke is a Southern woman's best friend: it has Coke, bourbon, and almost none of those nasty calories! Anyway, I later quit all coke (in my area of the country the generic name for all soft drinks was "coke" just like it's "pop" in some areas) because it was supposed to be bad for me in various ways.

I still hated water. I found it boring. Only in the last year did I take my water needs seriously. I drink about 80 ounces a day. I carry around a big plastic bottle with me and make sure to drink it all, plus more. While I used to get the water out of the tap, I started filtering with a Britta tank once my doctor told me I was registering high levels of clorine. I like water now, but I spend a lot of time preparing it and making sure I get it. I'm proud of how far I've come on the water thing . . . or I was, anyway.

At my studio, we offer a bottle of water to each client after the massage, with a choice of cold or room temperature. In this case, it's part of the corporate plan, but still a great thing, right? Water, not Coke or sugary sports drinks. Well, no, apparently not. We've had several clients decline, one very angrily, on the grounds that all these water bottles are going into landfills and destroying the environment. The angry client declared she was going to write a letter to my boss and complain (That's good manners, lady. I give you a nice massage, and you bite my head off about something I have absolutely no control over and which has nothing to do with the bodywork and which was MEANT to be a pleasant service to you.)

Let me add at this point that sometimes I just want to put my head down and cry. There is never enough money or time, my feet and shoulder hurt, I need health insurance and care, I'm depressed about everything from the price of fresh vegetables to oil spilling into the Gulf . . . and then I manage to get a handle on one thing (water) which is now all wrong because of the packaging. GOOD GRIEF! I find it ironic that the path between Scylla and Charybdis (the real names for the devil and the deep blue sea) was a watery one.

Sigh. Okay. So no plastic bottles. I reuse my own plastic one, but it drives my boyfriend crazy as he's certain it's breeding bacteria in addition to everything else. I guess I could get a metal one and try to remember to fill it three times a day, as I doubt I'll find one as big as my plastic one. As to the studio, we're letting corporate know that here in Seattle at least, offering plastic bottles of water is not always popular or appreciated. Our only thought is to go to paper cups, as we obviously can't send clients home with ceramic mugs. Of course, paper kills trees. I think perhaps a large oak bucket with a dipper outside the door might be an option, but I doubt most people would find that sanitary. It's too bad, though. Cold water out of a metal dipper tastes as good as Coke out of glass bottle on a hot day. And if you can't please everyone anyway . . .

Fight Noise with White Noise?

I think I'm becoming a Grinch about noise. Because it was the well-loved Grinchy-Claus who once worried,

 

...All the Who girls and boys
Would wake up bright and early. They'd rush for their toys!
And then! Oh, the noise! Oh, the noise! Noise! Noise! Noise!

Normally, I think total quiet is not only artificial, it's too much to ask. Even in the most womb-like of massage environments, you're going to get the occasional murmur of footsteps and voices in the hall, or the soft click of doors opening and closing. If the massage is compelling enough, both it and almost ever-present massage music should soften the effects of such normal every day sounds.

But lately, the noise in my studio has been increasingly annoying for both therapists and clients alike. On one side of us, we have a popular teriyaki restaurant. For a while, the merry Spanish music of the kitchen staff was invading us, though a kind request seemed to solve that. Unfortunately, we still have a vacuum cleaner advancing and retreating and slamming our walls everyday at mid-morning, as well as dining room noise in the evening (dishes clicking, babies squealing). On the other side, we have a cosmetics supply store, and their storage room backs up to our treatment rooms. After a kind request, they removed the doorbell that goes DING-dong, DING-dong, DING-dong every time someone enters their shop. On the other hand, they scuffle and stomp, sometimes assemble things with power tools, and occasionally bring in a small barky dog. And to complete the noise inventory, we have our own front desk noise that seeps through to my treatment room and our own breakroom noise which can invade the treatment room directly across the hall if the door isn't shut completely.

So we definitely have a problem to be solved, but how? The break room is the break room for heaven's sake. It shouldn't have to be a tomb, nor really can it be with hot stone carts being wheeled in and out and therapists doing laundry and dishes and discussing treatment techniques. As for the rest of it . . . well, the reason I think I'm becoming a Grinch is that my first thought was to go the nearby grocery stor--which should have honey and most everything else needed but ants--and go find the contractor who put the studio together. I know, I know, I'm such a nice, sweet girl. In any case, not only would that not be kind, it wouldn't be immediately helpful and because I doubt my boss is going to want to spend the money to break down and sound proof the walls, what do we do?

One therapist who deals with the teriyaki vacuum in her room, suggested white noise machines. She said she once worked with a talk therapist who used one to keep people outside the room from eavesdropping, whether intentionally or otherwise. So I did some researching on such machine and a lot of listening to shockingly wide variety of "white noise" sounds. Some of these sounds, I wouldn't call "white noise" just "background noise" such as rain, thunder, birds chirping, etc. Those sounds won't help. They'll just combine with the music, sometimes in odd ways. Then there are interesting sounds like one might use for sleeping infants such as "heartbeat." The sound of a heartbeat isn't horrible, but I think some clients might find the peculiar pulsing creepy. After all, Edgar Allan Poe isn't running the studio (thank goodness). The only sounds that I think might be helpful are "true" white noise, which from what I tell, sounds like different types of air rushing through fans. A fan sound without the chill breeze might combine with the music to almost eliminate our sound problem, though that's only a theory. If anyone out there has used white noise to combat annoying noise in a massage practice (or has any other opinion on the problem) please let me know. Fire ants simply aren't as available here as they were in Louisiana :-)