• Rachael Scott, BS, LMT

Health Insurance for Massage & Bodywork

Updated: May 12, 2018

In Washington State massage therapists are recognized and licensed as healthcare providers. That means that we can join health insurance panels and submit claims just like any other clinician.

However, massage is one of those professions that exists between worlds. Since you'll also see us in salons and spas offering body scrubs, hot stones and more. But we go further than that! Massage therapists can incorporate Traditional Chinese and Ayurvedic body treatments as well. We train in cupping, gua sha, bamboo massage and topical essential oils.

Toward the rehabilitation side we can incorporate passive movement therapies and advanced bodywork techniques that are also commonly practiced by physical and occupational therapists, such as Neuromuscular Re-education, Dermoneuromodulation and Manual Lymphatic Drainage.

It's a much bigger field than a lot of people realize, with a ton of variety in perspectives and approaches.

Now, back to the bit about insurance. It really is a double edged sword. On the one hand, insurance often does list massage as a "rehabilitation" benefit. It's generally lumped in with physical, occupational and speech therapy. Sometimes it's in the same category as naturopathic medicine, acupuncture and chiropractics. It depends on the insurance company's take on what we do.

That means that when you want to use your benefits, and ask your massage therapist to submit claims for your insurance to pay for your massage, those massages have to meet certain criteria. These criteria are set by the insurance company, and in some cases, by the employer who pays for (at least part of) the plan.

Each policy and situation has to be looked at individually, but here are the general rules that apply.

1- A prescription or referral from your doctor must be provided. The diagnosis code is required on the claim form that goes to insurance. Without an Rx, massage therapists cannot complete a claim form because massage therapists do not have the authority to diagnose.

2- The referral or Rx from the doctor needs to have a diagnosis that could reasonably improve with massage treatment. Generally, these are pain conditions. For example, "low back pain" "neck pain" "leg pain." And so on. We don't treat complicated issues. We help with pain. (We also help with anxiety but insurance doesn't recognize that at this time.)

3- The doctor or therapist has to establish a reasonable treatment plan that lasts no longer than (give or take) 90 days. Some plans max out at just four weeks! After the treatment plan ends, you have to go back to your doctor and discuss the condition. Has it improved? Is more care needed? If the doctor thinks it's reasonable to continue massage, then a new script or referral must be provided. (Sometimes insurance companies will want to do an internal review or third party pre-authorization at this time.) *Note: Even if your plan says you have 30 visits (or whatever) that doesn't mean you get to use those visits. There are rules to accessing them.

4- Insurance companies limit what kinds of therapies massage therapists can provide, and how long sessions can last. For example, if you have a prescription for neck pain, it's unlikely you'll be getting a nice foot scrub. The therapist can only provide massage (sometimes manual therapy/physical therapy techniques) for the specific condition. It's not a relaxation massage. It's focused treatment. Also, they tend to cap time at 60 minutes maximum. So no nice long 90 minute bodywork sessions, which are my personal preference btw.

5 - Every time you have a little ache or pain that comes up and you want a massage, and you want your insurance to pay for it - you have to get a new referral from your doctor. Every. Single. Time. So it's kind of hard to schedule in advance, isn't it? Usually by the time you get an appointment, it's already taken care of itself.

6- And finally, just to emphasize how limited your massage experience can be when you involve a giant profit-driven corporation, there's one last twist. What happens if your insurance company determines for any reason that they don't want to pay for your treatment? After you've jumped through all their hoops, and played by their rules they may still deny coverage and leave you stuck with a bill. And not just the regular $100 you might have paid out of pocket. You're going to be paying the full billing rate of $185 - or whatever your therapist charges. That's because, just like other healthcare providers, the majority of massage therapists give their self-paying clients generous discounts for saving them time and administrative costs. However, that discount disappears once a third party gets involved. It's all in the paperwork you sign when you start therapy. Make sure to read the fine print so you know how much you'll be on the hook for if your health insurance company leaves you high and dry.

Okay, so I know that this article takes a dim view of insurance for massage. That's mostly my fault. As a therapist in practice since 2004, I've seen so many messed up situations with healthcare that it makes my eye a little twitchy when I think about it.

Don't let this discourage you from using your health insurance to get care when you need it. Now that you know the system a little better, use that knowledge to make informed choices about your healthcare. If you want to be pampered and just relax - don't whip out your member ID card. It's not going to help you. But if you're in pain, need relief and are ready to rehab for one to three months - find someone who's familiar with the ins and outs of working with your insurance company and make the best of your benefits.


© 2018 by Rachael Scott, BS, LMT (MA00020214)

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