Clarifying Massage Coverage and Insurance Benefits

It has come to my attention the need for more education about massage therapy benefits and there coverage under insurance.

First, providership is essential for the practitioner, whom is qualified by credentialing and training.

Second, is the need to look at the individual (patient's) plan, provision and policy of the insured, whether it be an individual or group plan. Just because a provider is listed as preferred on your insurance plan does not mean you have benefits covering the provider's service. I have seen this provision be overlooked by the patient not knowing they have a deductible, co pay or co insurance. In most cases the deductible has to be meet prior to the insurance company paying out any claims. Co pays are typically a set amount per visit but can change under different provisions such as listing visit under rehabilitation and not under an office visit. Co insurance is the percentage that patients pays in addition or instead of a co pay. For example the insurance may only pay a portion say, 80 percent of the allowed amount, making 20 percent unpaid balance for the patient to be responsible for. To avoid confusion in benefits,eligibility needs to be authorized prior to starting care whether by the patient, provider or both.

Third, is the requirement of seeking out care. Most massage therapy coverage is under the rehabilitation out patient services, which combines with other services such as physical, speech and occupational therapy. This again is a combined benefit restricted to a dollar amount or sometime an actual set number of treatments typically per calender year. A patient can seek out combined care as long as a treatment plan is in place. Deductibles, co insurance and co pays need to be satisfied prior to the insurance paying for therapy. A treatment plan (a prescription) needs to be in place to create medical need; hence a diagnosis and frequency of care.

Massage Therapy benefits are not to be used for stress, maintenance or chronic pain management unless specifically indicated otherwise under a plan. Never is a full body relaxation massage recognized as medical treatment.

I agree, that the standard of practice in the medical field is focused on what is not functioning verses maintaining and preventing health as a holistic model. But this as of current, is the model the insurance company follows. Rehabilitation is defined as the recovery from an injury, trauma or disease processes to restore what was once normal to a returned state of functionality. Anything short of these provisions, unless stated otherwise is not a covered benefit.