According to MassageTherapy.com, most chiropractic and physical therapy treatments are reimbursed by health insurance, while more than 90 % of massage therapy sessions are paid out of the client’s pocket. So when it comes to receiving third-party insurance reimbursement for massage therapy, almost all work is related to a disability or accident rehabilitation, like workman’s comp cases or injuries sustained from an automobile accident. Health Insurance may cover for massage therapy services when prescribed by a chiropractor, osteopath, or other medical professional. These therapies may be provided as part of a prescribed treatment with a specific diagnosis and treatment plan.
How do you know if your Major Medical Plan covers Massage Therapy?
The easiest way to find out is for you to call the customer service phone number located on your insurance card and request information about your massage therapy coverage. You will want to follow a specific script to ask the right questions in order to verify your benefits. Click HERE for a detailed explanation on verifying your benefits. Because there are several different types of insurance, each insurance company and policy have different rules and conditions for when and how they will pay for massage. As a rule of thumb, the types of insurances that may pay for massage are: Major Medical PPO (Blue Cross, Aetna, Humana, etc.), Auto Mobile Insurance (PIP), and Workman’s Comp. A few providers that usually don’t pay for massage therapy services are: HMO’s, Medicare and Medicaid. After you have verified your coverage and obtained a prescription from a physician, you may start to receive medical massage with a Licensed Massage Therapist that is qualified to bill insurance companies. The massage therapist will need to have a National Provider Identification (NPI) number registered with the National Plan and Provider Enumeration System in order to legally bill for medical massage. What is medical massage you ask? It is a clinical massage based on a physician’s prescription, and performed with a specific goal for functional outcome. It is generally prescribed as a series of visits over a specific period of time, like 2x per week for 6 seeks, or 1x per week for 12 weeks. Typically the LMT may only work on the affected area, where an appropriate diagnosis code has been prescribed. Medical massage is usually paid for by a third party, such as an insurance company.
Excellent! My Insurance Company does cover for massage, but I am still confused on all of the terminology.
Make sure you gather information about your massage therapy benefits and understand the explanation of terms medical insurance companies use. You may be required to pay a Deductible before your insurance pays. This is the initial amount that must be paid out-of-pocket before the insurance company pays. The Co-pay is another type of out-of pocket fee to be paid to your service provider at the time of each service. Coinsurance, after the deductable has been met, there is a coinsurance percentage. This number tells you what percent of the service your insurance company will pay for up to an allowable amount. Many insurance plans will cover 100% after you’ve received a certain dollar amount in services; this is called a stop loss. The Allowable amount is the predetermined amount that your insurance is willing to pay for any given service. The Out-of-pocket expenses refer to a general term for anything that is left unpaid by your insurance company including deductibles, co-pay, and coinsurance. A Preferred Provider is what the insurance calls their contracted providers. Health care practitioners, including Massage Therapists must fill out an application and go through a rigorous screening process. In-Network is another term for a preferred provider, meaning that the given provider is working in that insurance company’s network. Out-of-Network is a term for practitioners who are not preferred providers, or rather who have not been contracted with your insurance company. Many insurance companies allow for their members to receive treatment from out-of-network providers under certain plans. Explanation of Benefits (EOB) refers to whenever your provider bills your insurance company for a service, your insurance company will send you an explanation of benefits. The EOB briefly explains what has been billed and how much was or was not covered and why.
I have recently been in a Car Accident / Workman’s Comp injury. Is the process the same for billing medical massage?
The process for billing for a Personal Injury Protection (PIP) claims and Workman’s Comp claims are a little bit different. With either of these claims, a medical adjustor will be assigned to your case. This is the person who is in charge of managing your claim, and whom the provider will work with directly in order to make sure you get the paid treatment that you need. Most PIP and Workman’s comp claims will remain open until you have reached the dollar limit for treatment, you are no longer affected by your injuries, or your claim becomes dated. In order to bill for PIP or Workman’s comp claims, you must also meet specific criteria. You will need to obtain a prescription from a physician, naturopathic physician or chiropractor. The prescription must include a diagnosis code, or codes, for billing purposes, the frequency of treatments, the total number of treatments, and the Name / UPIN # (doctors ID #) of the referring Physician. The prescription must also state that massage therapy is medically necessary. Furthermore, a claim number must be obtained from your auto insurance company (PIP) and the name of the claims representative from your insurance company who is handling your claim is needed for medical billing.