Submitting receipts

[RiverCityGuy 1025]

Wondering if anyone has submitted a receipt for their massages. I've got to sunhope and gmhave a receipt but I haven't sent it into BlueCross (I need to get a script from my Dr.)

[Trent4321 34]

Don’t do it. The insurance companies can have providers like this flagged and go after you for fraud. 

I have a friend who works in the fraud department at a major insurance company and he has warned me multiple times. They also will review boards like this to get dirt on providers. 

[Trent4321 34]

Best case scenario they just decline the claim. Worst case they notify your employer of fraudulent use of company benefits. 

[Ice4fun 78407]

In order for a massage to be claimed it would have to be a therapeutic massage from a registered massage therapist (RMT).  If the SP you see is a RMT I would assume she would not want to issue receipts for anything that was not a Therapeutic treatment or she would lose her license.  If your SP is not an RMT it would not be able to be claimed on insurance.

Just my Opinion 

[Blue0012 1699]

I made this mistake once. 712 when they first opened insisted they could provide receipts for BlueCross (direct bill for others). Being a dumbie I figured they knew what they were talking about. This was late in the year. Had three massages there and submitted. They were denied. When I asked why, and that the business had claimed that they were BlueCross redeemable (not sure that is the right word) BlueCross told me its not the business that is of interest to them its the 'specific' provider. They told me if I wasn't sure to call BlueCross ahead of time to confirm the providers eligibility, and that the receipt would have to have the providers name on it. Provider being the masseuse, NOT the business. 

Since that fiasco I only use places that direct bill. 

On a side note, it was not my intention originally to use those massages at 712. I had tried a number of 'legit' places because I wanted a place that direct billed BlueCross but being that there were only a few weeks left in the year all the places I'd tried were booked up into the new year. I must have tried a half dozen or more. Then 712 popped up on Ksite specifying they could provide receipts for BlueCross so figured I might as well. 

[RiverCityGuy 1025]

Ness gave me a receipt for the price minus tip, and did say she was registered. I just want to avoid the trouble.

I'm guessing all places that do direct billing are all on the straight and narrow

[Trent4321 34]

I went to a place on Marion that offers direct billing. I just paid up front and was planning to submit the receipt. I then noticed that the therapist listed on the receipt was the name of the guy at the front counter, not the girl I saw. Needless to say I did not submit the receipt. You might be less likely to be caught if they direct bill but it doesn’t guarantee they are billing legitely. 

[Ice4fun 78407]

From my perspective the types of Massage that are discussed on this site are relaxation massage and not therapeutic so are not eligible for insurance coverage so I would never risk claiming it under a workplace insurance as it is fraud and could comeback to affect your employment.

Just my Opinion

[livenudecats 4072]

Too many comments from people who are speculating.

At the end of the day as Blue00122 pointed out the claim would simply be denied.  It is not insurance fraud to submit an ineligible receipt.  Insurance companies deal with this all the time and simply deny the claim.  Insurance fraud is if you hurt your back playing hockey and try to tell WCB you slipped and fell at work.

As for your employer being informed that again should not happen.  While employers can access information such as claim history from insurers, they cannot under Privacy Legislation access the specifics of the claim.  For example if you submit a receipt for a prescription they can see you did and the amount but what the actual drug was is privileged information.  If the insurance company told them you could sue the insurer for privacy violations.

As has been stated, the vast majority of the massage providers discussed in this thread are not eligible for insurance claims and you're best to not submit them.  If you can't afford to enjoy this hobby out of your disposable/discretionary income then you should not be.

But saying that submitting a claim that gets rejected is tantamount to insurance fraud is a little far fetched.

And If you get fired becasue you tried to submit a receipt for a R & T, you can live off the award you'll receive form your lawsuit against the insurance company.

[f158 973]

@RiverCityGuy Why not just phone Blue Cross before submitting the receipt to see if that place is registered with them?  If yes then go for it I guess.

[Thanos 131]

LiveNudeCats is correct. The claims just get denied and all ownership of that claim getting denied is on the business as it is not my responsibility (or yours) to fact check every business. If a business says they have insurance I believe them. It is on them. If I'm lied to that's hardly my fault.

[Guest]

11 minutes ago, Thanos said:

LiveNudeCats is correct. The claims just get denied and all ownership of that claim getting denied is on the business as it is not my responsibility (or yours) to fact check every business. If a business says they have insurance I believe them. It is on them. If I'm lied to that's hardly my fault.

  One rejected claim is not issue. But when it becomes a pattern and the person or business are investigated for potential fraud, this is where it becomes problematic. You may not lose your job, but you'll likely lose some benefits. And if you end up losing your job(for whatever reason), the insurance fraud will certainly haunt you.

  Reason more to see if a therapist is approved before submitting a claim.

[Blue0012 1699]

To be fraud they'd have to prove that you received something other than a therapeutic session. Which they can't do. That's how I look at it anyway. 

[Thanos 131]

I agree Green, but that's just common sense to not repeatedly try at the same place. I myself have had good luck with most places. But Blue Cross is very finicky. So need to be careful if they are your provider. Even if you got multiple rejections it's not your fault if someone advertises they have insurance but actually doesn't 

[RiverCityGuy 1025]

I'll definitely have to call my insurance provider. I need a therapeutic massage for an old injury and thought maybe I could 'kill 2 birds with one stone'

Thanks for the input everyone

 

[Guest]

16 minutes ago, Thanos said:

Even if you got multiple rejections it's not your fault if someone advertises they have insurance but actually doesn't 

   The ability to write insurance receipts doesn't mean it will be accepted by all policies.

If a workplace and "therapy" feels questionnable with extras, I would think twice before submitting a claim. I would stick with health providers recommended by the insurer or health professionals

[Blue0012 1699]

I think I may have said this before, but going forward I'm not messing with submitting receipts. I got burned once before for three sessions. If the place doesn't direct bill its a hard pass for me. Thankfully when I got burnt, it was with a regular that was new at that location. She wasn't aware they'd be denied either, so she made up for it down the road. 

[Ice4fun 78407]

10 hours ago, livenudecats said:

Too many comments from people who are speculating.

At the end of the day as Blue00122 pointed out the claim would simply be denied.  It is not insurance fraud to submit an ineligible receipt.  Insurance companies deal with this all the time and simply deny the claim.  Insurance fraud is if you hurt your back playing hockey and try to tell WCB you slipped and fell at work.

As for your employer being informed that again should not happen.  While employers can access information such as claim history from insurers, they cannot under Privacy Legislation access the specifics of the claim.  For example if you submit a receipt for a prescription they can see you did and the amount but what the actual drug was is privileged information.  If the insurance company told them you could sue the insurer for privacy violations.

As has been stated, the vast majority of the massage providers discussed in this thread are not eligible for insurance claims and you're best to not submit them.  If you can't afford to enjoy this hobby out of your disposable/discretionary income then you should not be.

But saying that submitting a claim that gets rejected is tantamount to insurance fraud is a little far fetched.

And If you get fired becasue you tried to submit a receipt for a R & T, you can live off the award you'll receive form your lawsuit against the insurance company.

I guess you are assuming people are speculating ... I was not.

There is nothing therapeutic about the types of Massage we are talking about and it is only the rare situation where the provider is a RMT.  Making an insurance claim for something you know is not covered on purpose is in fact fraud.... I would totally agree that the likelihood of the insurance company doing anything more than deny the claim is very very very low.  

As for being fired if this issue was ever brought forward ... there are legal protocols around when an employer can fire someone for outside behaviour and the threshold is pretty high ... the activity would have to damage the employer and render the employee incapable of doing their job.  That said it is a little more complicated for jobs that require a security clearance...  if you lose this clearance as a result of your actions you may be ineligible to continue employment ... this is not being fired it administrative based on your ability to retain a clearance.

Just my Opinion 

 

[Trent4321 34]

The information that I was given from a friend who works within a fraud department at an insurance company was just that they could notify the employer that insurance fraud was taking place. He never clarified if they could reveal any details. 

This is the only part of this discussion I can say that I am pretty sure on. What an employer would do with that information I don’t know and needless to say I won’t be asking the HR department at my work to find out. 

[Guest]

7 minutes ago, Trent4321 said:

The information that I was given from a friend who works within a fraud department at an insurance company was just that they could notify the employer that insurance fraud was taking place. He never clarified if they could reveal any details. 

This is the only part of this discussion I can say that I am pretty sure on. What an employer would do with that information I don’t know and needless to say I won’t be asking the HR department at my work to find out. 

    The employers will only be notified if the insurance is part of work benefits package. And the information will only used against the employee if it become part of bigger work related problems. The best way to cover yourself is to have written recommendations from the insurer or a doctor on where to go for massages services.

[fresh 8278]

I didn’t read all the comments. I always think back to a CBC investigation report where they went undercover and found places billing out massages so customers could claim it when customers actually received nail services or other stuff.   

So what I am saying is 

why do we want to draw any attention to our hobby by sending in insurance claims. 

 

Unless you are absolutely sure your massage provider is trained in some kind of way that is accepted by your insurance company.  So read your policy and check the credentials of the provider.   

Putting in things that won’t be covered is just extra attention the hobby doesn’t need

[Guest]

27 minutes ago, fresh said:

I didn’t read all the comments. I always think back to a CBC investigation report where they went undercover and found places billing out massages so customers could claim it when customers actually received nail services or other stuff.   

So what I am saying is 

why do we want to draw any attention to our hobby by sending in insurance claims. 

 

Unless you are absolutely sure your massage provider is trained in some kind of way that is accepted by your insurance company.  So read your policy and check the credentials of the provider.   

Putting in things that won’t be covered is just extra attention the hobby doesn’t need

  Reasons more to only submit claims from establishments/RMT's recommended by your doctor or insurer. That way, even if the place gets investigated after, you got something in writing to cover yourself.