Massage Therapy Client Obligations and Responsibilities

Massage therapy is unique in that it is a profession with one foot in health care and another in the service industry. This bridging of worlds brings a certain set of responsibilities to not only massage therapists, but also to their clients.

In keeping with my previous postings concerning the therapeutic relationship, I have decided to enlighten massage therapy clients as to what constitutes behaviours which massage therapists appreciate and those which we don’t. A little give, take and understanding of what massage professionals go through on a daily basis might help you establish a better relationship with your therapist, putting you on the top of the pile for preferred days and times, as well as getting “squeezed in” on short notice.

Here are the top things you can do to establish a great relationship with your therapist:

1) Show up on time. Massage therapists really appreciate a client who arrives on time and ready for treatment. It helps our day go smoothly, ensuring we don’t get behind. It also demonstrates to us that you respect our time and profession, which we really appreciate.

2) If you are late, expect that you will pay the full fee even if your therapist can only treat you for the remaining time. And, some therapists will not treat clients at all who are more than 15 minutes late for the appointment.

3) Please call 24 hours in advance if you have to cancel. We understand that life happens, and if you don’t give 24 hours notice and this is an isolated incident, it’s not usually too big of a deal. However, do expect the cancellation policy to be enforced, and if you fail to pay the balance owing, you may be “discharged” from your therapists care.

4) Know your insurance policy, if you have one, before the treatment. There are many different plans which may or may not cover massage therapy treatments, sometimes even within one organization, such as the government. It is your responsibility, not ours, to know how much coverage you have, if a medical referral is required, if direct billing is allowed etc. A therapist, even if he or she does permit direct billing, has the right to ask for payment up front if you are not sure of what is covered or don’t have the appropriate information. A therapist may also only direct bill for certain insurance companies. While most therapists do their best to accommodate clients (within reason), It is our prerogative to decide how to run our business.

I advise calling your insurer well before your appointment and asking them things such as 1. to what association does my therapist need to belong for me to get reimbursed, 2. do I need a medical referral to get my treatments covered, 3. how much coverage do I have and how much will I get reimbursed per treatment, 4. is direct billing permitted, or do I have to pay up front and submit my receipts? If you do need to get a medical referral, do so before your treatment, as massage therapists and doctors cannot “fudge” treatment or referral dates so your treatment is reimbursed.

5) Comply with the treatment plan and recommendations, especially if you are going in for a specific reason, such as an injury. While massage therapists are not permitted to diagnose, and are only permitted to form a “clinical impression“, we usually have great suggestions for treatment plans and exercises to ensure the best possible outcome. Remember that as great as massage therapy is, it is a passive therapy and only part of the health management equation. If you suffer from tight hamstring muscles, but don’t do the recommended stretching between your bi-weekly appointments, then there is only so much your therapist can do to help.

In the case of a client who is receiving insurance coverage for a motor vehicle accident, he or she has to realize that massage therapists are obligated to report to the insurer if the client is “non-compliant” with treatment and home care recommendations. I have seen many people discharged for “non-compliance”, and I have discharged patients myself for this reason. In a rehabilitative setting it is our job to attain certain treatment goals which may not be reached if the client doesn’t hold up his or her end of the bargain. By discharging a patient, I am preventing insurance fraud and freeing up my time so someone else can benefit from treatment.

6) This may hit a nerve with some people, but I’m going to say it anyway – client hygiene is really important. I am not talking about someone who had a shower in the morning and goes to see their therapist after work needing to worry about hygiene. I’m talking about someone for whom hygiene is generally an issue. After all, if a therapist is obligated to maintain a certain level of hygiene to treat clients, the therapist should be able to expect that clients show up presenting a certain level of hygiene. Think about it like this, would you want to be in a small room in close proximity to, and touching, someone who hadn’t had a shower for a few days? I didn’t think so.

And a side note: refrain from using cologne or perfume or tons of hair and body products. It’s really hard to work in a closed spaced with someone who smells like they tried every perfume in the local drugstore. No scent is the best scent, and this ensures that your therapist doesn’t get a migraine or has a flare up of allergies.

7) This is a business, and for most of us, our livelihood. A lot of massage therapists have a hard time reconciling the business aspect of the profession with the “caring” and healing aspect of the profession. But, make no mistake, this is how we pay our mortgages and buy our groceries, not to mention everything else that we need to live.

Someone (I can’t remember who, but I thought she was brilliant) stated in a cartoon “the caring is free, but the service is ($80.00) per hour”. We may choose to do pro-bono work, or may offer reduced fees to long-time clients if there is sufficient reason, but these cases are exceptions that are made of our own volition. I have had potential clients argue and tell me how much I should be charging – the key word being “potential”, I refused to book them. I also won’t negotiate “deals” with people or give them bargains just to get them to be my client – this is devaluing my own professional worth and undercutting my colleagues. Kind of like buying groceries, the price is what it is, and payment is due when the transaction happens.

8 ) Be prepared to pay with the massage therapists preferred method of payment. Find out when you are booking your appointment what is accepted, and don’t expect to run a tab.

Massage Therapists also have obligations to their clients – please check out Massage Therapy Client Rights if you are unsure of anything.

Following these simple steps will ensure that you establish a great relationship with your therapist, and that you get the most out of your treatments.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

Massage Therapy Client Rights

Question: At my first massage therapy appointment, I asked the therapist some questions concerning the treatment. I found her to be evasive, and a little impatient with me. As a client, don’t I have right to know what is going to happen?

Yes, you certainly do. Here is a list of some of the rights you have as a massage therapy client.

1) Get some advice on how to find a licensed massage therapist – you have the right to know what qualifications your therapist holds. Ask where he or she went to school, to what professional association or college he or she belongs, and if they have any additional training. And remember, don’t discount a therapist just because he or she has recently graduated – there are some really fantastic new therapists who begin their careers every year.

2) You have the right to be informed about what to expect during and after a treatment. This is known as Informed Verbal Consent and is a set of statements designed to make the client aware of expectations concerning the treatment, as well as his or her rights as a client. Informed verbal consent goes above and beyond some typical quesitons, such as “do I have to take off all of my clothes” or “is it normal for the treatment to hurt?”. For any Canadian massage therapist who practices in compliance with the CMTO standards, informed verbal consent is mandatory before assessment or treatment begins and provides the client an opportunity to ask questions.

I have been disappointed to hear from clients who, when they’ve seen me for the first time, tell me that no
massage therapist has ever gone over informed consent with them. I cannot speak for students educated in the US, but Canadian massage therapists should really know better. We are obligated to advise clients what is going to happen. Period.

3) You have the right to receive treatment in a safe and hygienic setting. This is everything from the entryway of the clinic, to the bathroom and waiting facilities, and most certainly extends to the linens, towels etc that come into direct contact with the client. Linens should only be used with one client, and anything that comes into contact with the client’s skin needs to be washed after each use.

Equipment should also be safe, clean and in good repair, and there should be nothing on the floor on which a client could trip or lose footing. If the linen looks dirty, the equipment is wobbly or obviously broken or the
clinic is obviously unhygienic, you have every right to turn around and leave. (and I suggest you do)

4) You have the right to receive treatment from a massage therapist who is clean and hygienic herself. If there appears to be “hygiene” issues, you have the right to voice your concern and leave, you are not obligated to receive a treatment from someone who makes you uncomfortable or is unclean. I can pretty much guarantee that if a therapist doesn’t pay attention to his or her personal hygiene, that the linen and equipment will be lacking in this department as well.

5) You have the right to refuse treatment from a therapist who is ill. Your therapist should advise you in advance (preferably) or when you arrive if he or she isn’t feeling well or has a cold, and should not charge you if you decide to postpone treatment until he or she is feeling better.

6) You have the right to stop or modify the treatment at any time. If you are in a lot of pain, or for ANY reason you are uncomfortable, you do have the right to tell the therapist you want to stop. The therapist should respect your request and allow you to get off of the table and get dressed in privacy.

A massage therapists needs to receive informed verbal consent from you if he or she is going to be working in a “sensitive area” – for example, breast massage is not typically performed unless it is clinically indicated by your presentation or health history. Either way, it is always your choice whether or not to receive or refuse treatment.

If you feel that any inappropriate touching or remarks have been made, whether of a sexual nature or not, you have the right to report the therapist to his or her professional association. Please do so, as therapists who violate massage therapy professional standards and a position of trust do not deserve to call themselves massage therapists. In addition, therapists who engage in sexual misconduct commit a crime for which there should be repercussions.

7) You have the right to be advised of the massage treatment fees when you book your appointment. You also have the right to not be subjected to “upselling” or pressure sales tactics. The College of Massage Therapists of Ontario, and any provincial massage therapy association who follows their guidelines, require therapists and clinics to post their fees in a visible space for all clients to see. Anyone who doesn’t do this is in violation of the policy.

8 ) You have the right to know what products are being used on you. If you have a health issue such as an allergy, or an objection (for example) to products tested on animals, you need to ask this when you are booking your appointment. Remember, though, that a therapist also has the right to know of any issues in advance so he or she can be honest with you, whether or not he can accommodate your request.

9) You have the right to receive your treatment on time. Occasionally a therapist may run a little behind, for example, if the previous client was late; however, if this is habitual, then it shows an issue with your therapist’s time management. While the duration of the appointment will probably be reduced if YOU are late, if your therapist is late, you should receive your full treatment.

If the therapist is so late as to keep you from other commitments, you have the right to leave without incurring a charge. After all, you were ready at the agreed upon time.

The above points are some of your rights, but do realize that a therapeutic relationship between a massage therapist and client is based on mutual respect. If for any reason you don’t feel the situation is working out for you, please consider finding a therapist with whom you have a “good fit”.

© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

Massage Therapy and Preventing Missed Appointments by Clients

A Massage Therapist’s point on view on preventing and dealing with clients who miss appointments.

It happens to the best of us. Our day is booked solid, and we are all set to go full throttle. At some point during the day, a client doesn’t show, doesn’t even call to say that he or she is going to miss the appointment. Then another one misses an appointment. What is going on here? Our day is ruined by missed appointments and the no show client, and instead of being productive, we are stuck reading the newspaper when we’d either rather be treating, or at the mall/beach/movies. You feel disrespected, and yes, possibly, a little abused.

Let me just start by saying that most of our clients don’t miss appointments on purpose, usually it is a case of life getting busy and they have forgotten about it. I have been on both sides of that fence, and I have some strategies that can help prevent and deal successfully with the dreaded “no show” or “dns” (meaning did not show).

1) To begin with, I suggest that you create and post a cancellation policy and use a standard script when booking a new client. If you use a receptionist instead of booking your own clients, I suggest that you make friends with him or her and encourage them to use it when booking for you. When booking a new client, I ALWAYS advise them of the cancellation policy – you can say something like this:

“Your appointment time is reserved just for you, and if you should need to cancel, I do require 24 hours notice. In the event that you fail to provide the required notice, there is a charge of (i.e. 50%) of the fee. And in the event that you arrive late for the appointment, you will be charged the full fee, even if I am not able to treat you for the full duration of the time you’ve booked.”

This way there are no surprises – your script will become like second nature to you, and it is better to be up
front about your expectations – this way the client can’t come back and say that he or she didn’t know.

2) How you approach this is also going to depend on the situation in which you work. If you are a contractor, then you should have complete control over your clients and how you interact with them, establishing your own policies (within reason, of course). If you are an employee, then the control you have over how you handle these sorts of things may be limited by the policy of your employer – and this may or may not work to your advantage.

The College of Massage Therapists’ of Ontario (CMTO) requires that massage therapists post treatment fees in their place of practice where they can be easily seen by incoming clients. I think this is a really great idea, as there will be no surprises and the expectations will be clear. Also, it is a great opportunity to post your cancellation policy along with your fees, though I did have one clinic owner who had a problem with this (apparently it was “aggressive and tacky”) – I did notice, however, that my clients were very clear and accepting of the policy, and as I was in compliance with CMTO standards, it didn’t really matter what this individual’s opinion was. Ultimately, I had to answer to the professional college first.

Under your posted fees, you can indicate your cancellation and late arrival policy – it can be something like:

Your appointment time is reserved just for you. I respectfully request 24 hours notice to cancel an appointment, or full payment will be required. Full payment is also required if you are late for your appointment, or fail to show for your scheduled booking. Thank-you for respecting my time.

3) You don’t have to be so rigid with this policy as to drive away clients. Find your balance between fairness (towards all of your clients) and firmness (you are running a business, and when you treat it like a business, clients will see it as a business). Without telling clients this, I usually give them one missed appointments grace. This is only fair, as sometimes life just happens – children (or the client) get sick, things are busy at work and it slips their mind, the car breaks down, they get stuck in traffic… you know what I mean. It did work for me, and here is how I let them know that the next time the policy would be enforced …

4) When you call your client to let them know they missed their appointment, you should make it as non-confrontational as possible, their reason for missing the appointment may really be very innocent and legitimate. You can say something like “I am calling to make sure you are OK, you had an appointment booked with me at 3:00 and you didn’t show. Can you just give me a call to let me know all is well, and then we can rebook you?” Usually they will call and be very apologetic, if they’re not, when you document the missed appointment in their file (and when you called them, if you left a message, what was said, etc), you need to note this as well.

When you do speak with him or her, what you can say is “I’m glad you’re OK, and I will waive the missed
appointment fee, as it is the first time this has happened. If you should miss any more appointments, you will be charged the missed appointment fee. When would you like to rebook?” They are usually happy with this, and have gotten the message loud and clear about the expectation the next time they miss an appointment.

5) Your policy enforcement will also depend on the relationship you have established with your client. Is the
client relatively new? Or has your client been loyal to you for a while? A loyal client who has a family member who is ill or has a special needs child, for example, may not show due to a family emergency. If you have already established a good relationship with this client and you know you are not being taken advantage of, then I would let an occasional missed appointment go.

6) The reminder call can work wonders, even though it is a little time consuming. For your own sanity, you may want to get into the habit of doing this the day before the appointment – it can go a long way in preventing a no show, and give you time to book someone else if your client can’t make it.

Another issue which is directly related to massage therapy is fraudulent billing for missed appointments, if you haven’t encountered it, you should read about it, it will be an issue at some point.

These are just some pointers in how to deal with no-show clients, please stay tuned for my upcoming post on Massage Therapy and How to End the Therapeutic Relationship, for those clients with whom you “just can’t seem to make it work.”

© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.