Prospective patients will almost always ask if their laser therapy treatments will be covered by insurance. Do you know what to say?
Does insurance cover laser therapy?
This question actually has several answers these days (2021). Depending on your state and what type of provider you are, the answer could be yes. Note, however, that being able to bill for PBM does not necessarily mean you'll get paid!
We are focusing on healthcare scenarios in the USA for this post. International situations will vary. Contact us for additional resources. Nothing in this article is a replacement for competent legal advice; you must perform your own assessment with your legal team for your particular situation.
MD, DO, NP, DDS, DMD, DC - can supervise and bill photobiomodulation in all 50 states
DPM, PT, OT, LAc, OD - can perform and bill photobiomodulation in most states with some restrictions
PA, LMT, LPN, RN, PTA, midwife, clinical psychologist, medical assistant - can perform PBM only under supervision in most states
Remember, ALL healthcare providers must stay within their scope of practice and follow all state and federal laws and board guidelines.
Medicare/Medicaid - medical providers may be able to bill and collect a small allowable
Private Insurance - most plans will reimburse varying amounts for most providers
Personal Injury/Auto Accidents - most plans will reimburse most providers at 100%, at least for 6-12 sessions
Worker's Compensation - nearly every state is different!
Do you want to accept insurance?
For many healthcare providers, you may wonder if it's even worth billing insurance for laser therapy. Between visit limits, shrinking allowables, repetitive appeals, closing networks, pre-authorizations, and seemingly arbitrary payment determinations, there may be a lot of drawbacks. Of course, this might be offset by lowering the amount your patients are responsible for, and the subsequent increased volume you might sustain.
Some providers may choose to stay out of network yet bill for light therapy, but this practice can still result in limited collections and increased patient portions.
If you're going to provide light therapy in a self-pay model, you'll need to determine a proper fee schedule with any discounts you want to provide. Check out our done-for-you FREE calculator that ensures you're charging enough to cover your costs and ensure a profit.
What do you tell patients who ask, "is laser therapy covered by insurance?"
If you don't accept insurance, you don't want to go straight to "no" as your answer. That shuts down further discussion and may prevent that patient from getting the care they need. If you don't take insurance, in many cases your rates may be less than or about the same as the patient's co-pay/co-insurance (especially considering deductibles and visit limits). Instead of "no," a better response might be:
What insurance plan do you have?
What's your copay?
Have you met your deductible?
The goal is never to be deceptive, but simply to get the conversation rolling. This will give you more insight to the patient's situation and allow you to talk with them about your discounts.
If you do accept insurance, make sure you don't give a blanket "yes." Just accepting insurance does not mean that their plan will pay your fees. Always let the patient know that you'll need to verify their benefits to know what the insurance MIGHT pay. There's never a guarantee that the patient won't be left holding the bag.
What should I charge for laser therapy?
This is a super common question and the answer is pretty complicated. There are a lot of factors to consider when you're pricing photobiomodulation treatments. You have to earn a good ROI, pay your staff, and be compensated for your expertise. There's a lot to consider here, which is why we built a NEW free return on investment calculation tool with our decades of clinical and business experience. Simply fill out the form to get a personalized pricing assessment and so much more.