Cover My Care’s Toolkit

Cover My Care – the new outreach program for IHPC – has recently released their 2706 Toolkit.

From the CMC Toolkit page:

Our 2706 Toolkit provides information and tools for anyone interested in advancing the purpose of Section 2706: educating officials in your states, insurance company management, the local media, and joining or forming groups of consumers, patients and providers who insist that full access to affordable licensed providers is important to health care choices now and for the future.

Whether you’re a CAM practitioner or a patient who utilizes integrative medicine, the Toolkit has plenty of material for you to share with friends and clients.

Stay tuned! Coming soon to CMC: A page where you can share your stories of insurance denial and read what other patients have been going through.

Cover My Care

IHPC has introduced the next phase in their mission: Cover My Care.

This grassroots program is designed to “create public advocacy for access to all healthcare providers who are licensed in the states.”

Cover My Care’s objectives include:

      • Telling stories from all across America where these therapies are bringing relief and restoration of health to people.
      • Telling how these therapies are finding their way into standard medical practice: in medical education, in everyday care and in programs of wellness and prevention: in cancer, pain management, chronic disease, and stress management.
      • Providing toolkits and connections that can help you make the case in your state.
      • Making known the substantial medical education and professional certifications that practitioners in these disciplines must obtain in order to win licensure in their state.

They already have a number of posts on topics such as government relations, uses for alternative care, and updates on state licensing. The website is still in its early phase, but new posts are added every week. Make sure you bookmark Cover My Care and continue to check back!

Cover My Care Website

Cover My Care Facebook Page

Cover My Care Twitter

Credentialing with Insurance Companies In Oregon

I’ve had several people ask me about the steps to be a credentialed massage therapist in Oregon, since it’s already something the state allows (albeit in small, uneven doses). It’s a really easy process, and I wanted to put it all out on this blog for anyone to reference.

First of all, make sure you have an NPI number.

To apply to most insurance companies, you will need the Oregon Practitioner Credentialing Application, which can be found here. Fill out all of the sections that apply to you (many sections, such as Residencies and Hospital Affiliations, do not pertain to LMTs). Keep an unsigned and undated copy of the application in your files, just in case you want to apply to more insurance companies later.

What you will need to submit to the insurance company:

  • Credentialing application
  • Copy of current license
  • Copy of current liability and malpractice insurance
  • Signed W-9 form

Some insurance companies may want you to fill out another form or two (about your specialties, etc), so make sure to look at each company’s website or call provider relations to figure that out. Other companies will want you to fill out the application online instead of sending in a paper copy, which means you’ll have to scan and upload all of the supporting documents.

After you fax or mail in the relevant paperwork to the insurer, it will take upwards of 30 days to hear back. Eventually, you should receive a letter welcoming you into the insurer’s network, along with some new paperwork and a contract to sign and return. And that’s it! Now you’re credentialed. Remember to check on benefits before your client comes in.

(Unfortunately, if the insurance company decides to not let you into their network, they may not tell you – so make sure to call and check up on any that you haven’t heard back from.)

What insurers are big in Oregon?

Below I’ve listed some of the insurance companies that are big in the Portland metro area, as well as those found on the Oregon Exchange*. To find out what insurers are prevalent in your area, talk to your clients and colleagues.

*Please note that insurers whose plans are only available via the Oregon Exchange might not have any plans with massage coverage, and therefore may not be accepting LMTs into their networks at all.

  • ASH: This is a CAM specific insurer that many other insurance companies use. Credentialing with ASH will allow you to work with Health Net, Aetna, and many others.
  • CAQH: Sign up here to get credentialed with Cigna, Optum, United as well as many others (see full list here.) CAQH uses an online form instead of the paper application.
  • The CHP Group: This is a CAM specific insurer that many other insurance companies use, including Kaiser Permanente
  • First Health
  • Lifewise
  • Moda
  • Pacific Source
  • Regence Blue Cross Blue Shield: Joining this network will also give you access to other BCBS health plans.
  • Atrio: A Medicare-specific insurer, serving Douglas, Klamath, and Polk counties via the Oregon Exchange.
  • Bridgespan Health: A new insurer with plans available via the Oregon Exchange. Credential with Regence BCBS (above) in order to work with this company.
  • Oregon Health Co-Op: A new insurer with plans available via the Oregon Exchange.
  • Trillium: Serving Lane county via the Oregon Exchange.

Section 2706 Guidelines in Oregon

It’s time to follow up on my last post. The Oregon Insurance Division finally released the official Section 2706 Guidelines. Here they are, in full:

Public Health Service Act (“PHSA”) Section 2706(a), as added by the Patient Protection and Affordable Care Act, prohibits an issuer of a commercial nongrandfathered group or individual health benefit plan from discrimination with respect to participation or coverage against a provider who acts within the scope of the provider’s license. Section 2706(a) applies to commercial nongrandfathered individual and group health benefit plans issued or renewed on or after January 1, 2014.

The Insurance Division of the Department of Consumer and Business Services (“the division”) will review complaints related to Section 2706(a) on a case-by-case basis under the division’s existing complaint and market regulation framework.

So… what does that mean? On the surface, there isn’t anything new; the guidelines merely states that Section 2706 is the law, and any breaking of the law will be dealt with. However, this is a significant (and positive) change from where things stood last year.

I only touched on it very briefly in this blog post, but last summer the Health and Human Services (HHS) Department had released their own guidelines regarding Section 2706. These guidelines showed a huge misunderstanding of the law itself and its intent, telling insurers that they could implement the requirements of this section using their own “good faith, reasonable” interpretation of the law, and that they didn’t have to accept all types of providers into an insurance network if they didn’t want to.

This wasn’t an accurate read on the law, but because these were the guidelines that HHS had provided, it was what the states were going to follow. That was the starting point of the conversations between the Insurance Commissioner and the CAM provider associations back in October. The fact that the law will now be enforced as it was intended is a huge accomplishment.

Of course, this doesn’t solve all the problems, especially not immediately. No one is going to get a new insurance policy in the mail saying that they now have CAM coverage. And, truth be told, most insurance companies aren’t going to change the way they process claims without some arm twisting. Claims will still get denied for matters involving provider discrimination.

But now we have recourse. Now we can (and are expected to) file complaints with the Insurance Division and point out this discrimination. And you know what? The Insurance Division is on our side. They want insurance companies to follow the law.

I’ve said it before, and now I really mean it: Getting this law enforced is going to take work. And now it’s up to us to do the work.

What can you do (as a CAM provider in Oregon)?

  • Get credentialed. We’re incredibly fortunate to work in one of the few states that allow massage therapists to join up with insurance networks, so we need to take advantage of that. There are a number of insurance companies that will happily accept LMTs into their networks, and there are some that will tell you they are no longer accepting new applicants. Apply to both types of companies, and document what happens if you get denied. I’ll talk more about this in the next blog post.
  • File complaints. If you are already an in-network provider with an insurer, challenge the claim denials you receive. The Insurance Division has a created a special Complaint Form for providers to fill out – you can file all of your complaints in one batch. You can find that form here.
  • Reach out. Tell your coworkers to get credentialed. Ask your cash-pay clients if you can try billing their insurance – even if you know you’ll get denied. Your clients can also register their own complaints using the main Complaint Form, so make sure to pass that along if they’re interested.
  • Communicate. Did an insurance company reject your credentialing application? Did you file a complaint with the Insurance Division? Let us know. Shoot me an email, or let AMTA-OR know (if you’re a member, of course). The more we communicate with each other and across professions, the stronger our case will be.

The future of this law depends on us. We need to do everything we can to make sure it succeeds.

Oregon and Section 2706

I thought that Oregon would be ahead of the game when it came to the Affordable Care Act roll-out, especially as it pertains to CAM providers. The state already issues licenses for most types of CAM practitioners (notably, massage therapists and naturopaths), which means that they understand the necessity of having a diverse range of medical providers available for treatment. Surely, they’d be on board with Section 2706, the provision that makes it illegal for insurance companies to pick and choose the types of providers they cover.

But then the Exchange opened. By and large, the policies being offered there (which, by their very existence, needed to conform to the rules outlined in the ACA) did not offer CAM of any kind. Only the policies at the very top – platinum plans as well as a few gold plans – covered naturopathic, chiropractic, and acupuncture.

Massage? Don’t even bother asking. Massage coverage wasn’t a category on the Cover Oregon website at all, due to the fact that zero plans on the exchange offered it.

Wait, it gets worse: Many insurance policies that weren’t from the exchange (ie, plans available through employers) were changing in January – ostensibly to fall more in-line with ACA regulations. For at least a few of these plans, these changes included the removal of previous CAM coverage. Definitely not in compliance with the new regulations, but who was going to argue?

Well, plenty of people were going to argue. But who was going to listen or do anything about it? Passing a new law is easy compared to the cumbersome task of actually enforcing it.

Since the Exchange began in October, the Oregon’s insurance commissioner has received an earful of complaints, from groups like the local naturopathic and chiropractic associations, as well as from our local AMTA chapter. Progress has been slow.

When I personally emailed the commissioner’s office in November, I was told the following: “The Oregon Department of Justice is currently reviewing draft guidance on Section 2706(a) of the Public Health Service Act that was drafted by the division. We hope to issue final guidance later this month.” Will the ODOJ interpret the law as it was originally intended? What will that mean for the thousands of policies already in force that discriminate against providers?

It’s now January – the Exchange plans have started, the Affordable Care Act is fully active – and there still hasn’t been any word. The insurance commissioner met with the Oregon House Committee on Healthcare last week, and she assured them that guidelines would be issued by the end of the this month. Now that she has to answer to the legislature, she’ll hopefully be held to her promise. Naturally, I’ll update the blog as soon as I hear anything.

How to Take Insurance (2) – Checking Benefits

Your first insurance client has scheduled a massage with you. She’s not sure about the details of her coverage, but you assured her that you would check on her benefits before she came in. How do you begin?

Information you need on hand before calling:

  • Your tax ID (SSN or TIN)
  • Your NPI number
  • Client’s name
  • Client’s date of birth
  • Insurance ID number – this is the main number on someone’s insurance card. Usually it’s just numbers; occasionally it’s a combination of letters and numbers.
  • Customer service phone number – this is usually found on back of the insurance card.

The customer service phone number is almost always the most direct line of contact when enquiring about benefits. If you don’t have it, that’s ok. Call the insurance company’s main number and say that you need to check on a client’s benefits; they will transfer you to the right place.

Now you’re on the phone with a customer service rep. They have just found your client in their database. What questions should you ask? What do you need to know?

  • Does the client have coverage for massage? What CPT/billing codes can the massage therapist use for treatment? As I’ve written about before, even though massage therapists can use the two main “massage therapy” CPT codes interchangeably, many insurance companies have different rules governing both of them. It’s best to find out these details early so that your claim will not be denied on a technicality.
  • What is the allowed number of treatments per year? What is the allowed amount of money for treatments per year? Many insurance companies will have a treatment number limit as well as a spending limit – they will stop paying for treatments after either one of these limits is reached*.
  • What is the copay or coinsurance for treatments? Copay is a flat amount of money; coinsurance is a percentage of the total bill.
  • Does the client need to meet his or her deductible before insurance will pay for these benefits? If so, how much is the deductible? How much of the deductible has the client reached so far? If the deductible has not been met, insurance will not reimburse you. Instead, they will add the billed amount to the deductible. Once the deductible is met, they will start paying for subsequent treatments.
  • You might be wondering: Do I have to go through the hassle of calling on the phone? What about checking for benefits online?

    Checking benefits online can indeed save time, but it depends on the insurance company as to how easy their website will be to navigate (and how reliable their information will be). I would recommend calling about benefits, at least initially, to best ensure accuracy.

    As an aside, all insurance companies will require you to register for their website in order to fully access it, which you can only do as an in-network provider.

    The customer service rep is giving you all the details about your client’s massage therapy coverage. What should you do?

    Write it down. All of it! Ask questions if you are unclear about what they tell you. Believe me – it’s better to know too many details about your client’s coverage than to have to call back an hour or a week later and go through the whole process again. The more you know up front, the smoother the whole billing procedure will be.

    *Restricting access to services by limiting the number of treatments available per year (or limiting the benefit amount) may not be legal under Section 2706, but because we aren’t yet sure of these details, this is still relevant advice.