Two massage insurance claims in one day

Airbum88 wrote: ↑ My insurance plan only covers up to $105 for a massage. Nowadays, a lot of massages are going for $110 or more.
Is it okay to book two massage sessions in one day?
Will the insurance companies deny these claims?

Everybody's plan is different you'll have to call then to find out the limitations. If you are trying to double bill your insurance to cover the entire cost of one session by booking two and only using/paying for one it won't work.

tew wrote: ↑ Everybody's plan is different you'll have to call then to find out the limitations. If you are trying to double bill your insurance to cover the entire cost of one session by booking two and only using/paying for one it won't work.

I was thinking of doing a 45 minute massage twice throughout the day - morning and afternoon.
I wasn't thinking of asking the RMT to split the bill.

From experience, it will be denied. Even if you see two different therapists, the insurance will still likely deny because they'd be asking why you'd be receiving the same health care twice on the same day with two different practitioners at multiple locations.

And I know you mentioned you won't be doing this but for anyone else thinking if the practitioner can split your invoice, they won't, it's insurance fraud and prof misconduct.

What if I get a massage once a day? Is that a problem?
I don't think these are questions that insurance companies want to be answering...

Airbum88 wrote: ↑ I was thinking of doing a 45 minute massage twice throughout the day - morning and afternoon.
I wasn't thinking of asking the RMT to split the bill.

Airbum88 wrote: ↑ What if I get a massage once a day? Is that a problem?
I don't think these are questions that insurance companies want to be answering...

That's what the customer support phone number is for, to answer your questions about your benefits plan. Most plans have a total $ limit as well as a per session cap. Some even need a doctors note these days. I'm not sure shortening the session time will solve your issue. The $105 may be an hourly rate limit, meaning a 30 minute massage may only be covered for $52.50. Only way to be sure is to call.

Airbum88 wrote: ↑ What if I get a massage once a day? Is that a problem?
I don't think these are questions that insurance companies want to be answering...

Once a day isn't an issue, as you'd only be seeing one practitioner for one type of health care service. If you want to get one every day then that's your decision, and if it's with the same practitioner, then as long as he/she and you agree & consent to that treatment plan & schedule, then it isn't an issue.

But I thought your issue was with being reimbursed to a session maximum and therefore not getting back 100%? Whether you go everyday or not is not going to lower your treatment fee. Further, if your treatment is $110 and you're reimbursed $105, you're concerned about paying $5 out of pocket? I'd say that's a pretty good insurance policy.

if they cover 105, then that is all your allowed to be reimbursed for, you will be out of pocket for $5 and what ever else you provide as a customary tip.

Just pay the extra $5 for heaven's sake.

$5 + customary tip for a rmt is a heck of a deal.

chimaican wrote: ↑ Once a day isn't an issue, as you'd only be seeing one practitioner for one type of health care service. If you want to get one every day then that's your decision, and if it's with the same practitioner, then as long as he/she and you agree & consent to that treatment plan & schedule, then it isn't an issue.

But I thought your issue was with being reimbursed to a session maximum and therefore not getting back 100%? Whether you go everyday or not is not going to lower your treatment fee. Further, if your treatment is $110 and you're reimbursed $105, you're concerned about paying $5 out of pocket? I'd say that's a pretty good insurance policy.

My plan only covers up to 90%. So it’s 90% out of 105 + $5

Blanche123 wrote: ↑ Just pay the extra $5 for heaven's sake.

This is redflagdeals

Airbum88 wrote: ↑ My plan only covers up to 90%. So it’s 90% out of 105 + $5

90% is still awesome!

I have patients who only get reimbursed max $25 per treatment.

chimaican wrote: ↑ 90% is still awesome!

I have patients who only get reimbursed max $25 per treatment.

Wow that’s low. Are they part time employees?
I’m at a company that allows us to pay more for extra coverage. I have the highest plan. Lowest is 0% and 50%.

Blanche123 wrote: ↑Just pay the extra $5 for heaven's sake.

Airbum88 wrote: ↑ This is redflagdeals

Yes, redflagdeals, not cheapbuggers.ca. You're trying really hard to find a loophole/workaround to save five measly bucks.

some people have a spouse and can co-ordinate benefits with their spouse so if they're insurance only pays 50 to 80 percent, they can claim the remaining balance at their wifes insurance and maximize their coverage

Many plans have a max amount for their customary charge, the portion covered, and the amount allowed per year. For example, they cover 80% of the customary charge rate (say $105). That means you will be paying $21 + any additional amount the RMT charges over the $105.

If your allowance is say $400 a year, you basically will get the 80% covered for under 4 visits and anything else will be out of your pocket. It won't make sense to book 2 45 min sessions with 2 different RMT's as most people just book the 60 or 90 min with the same person so that the treatment is uninterrupted, and the 90 min rate is lower than 2x 45 min.

If you have a spouse or partner who has insurance, you might be able to split the cost by putting the balance on their policy.

I'd suggest you read your benefit package to see what it offers and then call the insurer if you have further questions as that is what they are there for. Also, check the insurer site to see what providers are NOT covered or on some blacklist as insurers review files and if some providers are doing something to circumvent the rules, they will be banned and you will be paying the full amount from your pocket. Also, your future claims may also be flagged for review as you would be on a "watch list".