I have been credentialed as preferred provider for the following insurance companies:
First Choice Health Network
Premera Blue Cross
Personal Injury Protection (PIP)
Labor & Industries - WA (L&I)
Some insurance plans even allow their members to seek treatment from providers who are out-of-network. Unfortunately, I am unable to accept any insurance plans under Regence or GroupHealth at this time.
Explanation of terms:
Deductible: The initial amount that must be paid out-of-pocket before insurance kicks in.
Co-pay: An out-of-pocket fee to be paid to your service provider at the time of each service.
Coinsurance: After a deductible has been met, there is a coinsurance percentage. This number tells you what percent of the service your insurance company will pay for (up to an allowable amount). Many insurance plans will cover 100% after you've received a certain dollar amount in services (this is called a stop loss).
Allowable amount: This is a predetermined amount that your insurance is willing to pay for any given service. Some insurance companies that claim to cover 100% of a service, will only do so up to an allowable amount. That amount could be lesser than the cost of the service, therefore still leaving you with out-of-pocket expenses. We encourage you to research allowable amounts when choosing insurance plans and health care providers. Things aren't always as they seem.
Out-of-pocket expenses: This is a general term for anything left unpaid by your insurance company, including: deductibles, co-pay, and coinsurance.
Preferred Provider: This is what insurance calls their contracted providers. In order to become a preferred provider, health care practitioners must fill out an application and go through a rigorous screening process.
In-Network: This is another term for a preferred provider, meaning that the given provider is working in that insurance company's network.
Out-of-Network: This is a term for practitioners who are not preferred providers, or rather who have not been contracted your insurance company. Many insurance companies allow for their members to receive treatment from out-of-network providers under certain plans.
Explanation of Benefits (EOB): Whenever your provider bills your insurance company for a service, your insurance company will send you an explanation of benefits. This paper briefly explains what has been billed and how much was or was not covered and why.
PIP and L&I:
In addition to insurance, we also bill for Personal Injury Protection (PIP) claims and Labor and Industries (L&I) claims. The process for these are a little bit different, but, again, we'll do all of the researching and billing for you. With a PIP and L&I claim, you'll have an adjustor assigned to your case. The adjuster is the person in charge of managing your claim, and whom we'll work with directly in order to make sure you get the paid treatment that you need. Most PIP and L&I claims will remain open until you've reached the dollar limit for treatment, you are no longer affected by your injuries, or your claim becomes dated.
Why You Need a Prescription for Massage Even if Your Insurance Plan Says You Can Self-Refer:
You always need a prescription for medical massage, even if your plan says you can self-refer. Here's why. It's not in my scope of practice as a massage therapist to diagnose, yet the insurance billing forms require a diagnosis code before they will pay. So, I always need a prescription from your doctor before commencing medical massage treatments.