Q. What insurance companies will pay for massage?
A. In most states you can bill insurance for car accidents and for workers compensation plans. I have been creating a list of states and what insurance is accepted there, but it is far from complete. Please share what you find out. More states have health insurance plans that are covering massage. Medicare Advantage Plans are now paying massage therapists. The Veterans Administration has recognized massage therapists and created a job description for them so we can work in the VA system. The call for massage therapy to be covered by health insurance is getting stronger everyday. Here is a list of things that have happened in the last 10 years or so.
Q. Can taking insurance help my income and business during this pandemic and resulting economic downturn?
A. Yes it can. People who come in using their insurance come weekly or even 2-3 times a week depending on the severity of their injury or condition. You can do a little research to see if taking insurance would help your business by calculating your cost per client and then seeing if taking insurance would change that.
Q. If a law gets passed allowing massage therapists to bill in my state or across the US, does it mean that I will have to take insurance?
A. Not as far as I know. Here in WA you choose whether or not to get on the provider panels and bill insurance. It will always be optional as far as I know right now.
Q. How much extra paperwork and time is involved?
A. Things are so much easier today than they were when I first started 30 years ago. Everything is done electronically. Checking benefits and verifying coverage are done through portals like www.onehealthport.com and www.availity.com .
Filling out the CMS 1500-2 and submitting it to insurance companies is done through clearing houses which are free or low cost like www.officeally.com
Charting is usually a simple process when you have the right form. I still use a paper form and it takes me a minute or two after the appointment. There is also online charting systems like www.handshealehr.com that are making it easier and easier.
Payments are deposited right into my checking account and I check online for the Explanation of Benefits to see who the payment was for.
Q. I have heard you can bill insurance companies more for the paperwork time and other things that go into a session. Is that true?
A. It is insurance fraud to bill different rates to different people for the SAME SERVICE. If you have a client come in with an injury and you are not billing insurance, you have to charge them the same as you would if you were billing an insurance company. I have heard so many different examples of people using different reasoning in order to charge more for insurance cases. I have only seen it hurt the profession overall when the insurance catches on and starts asking you to reduce your bill or the health insurance will reduce their allowable fees and number of sessions in their benefits. I explain it more in my book The Massage Insurance Billing Manual
Q. Does health insurance cover wellness/relaxation/preventative massage therapy?
A. No not in WA at least and it probably won’t for awhile. It works just like Physical Therapy. When people have an injury or condition that massage therapy can help, doctors will prescribe massage therapy. Insurance plans all have a definition of medical necessity which usually reads something like this: Massage therapy must reduce pain AND improve function and does not cover maintenance massage.
Q. Won’t taking insurance limit what I can do with a client/patient as far as the work I do and the care I provide?
A. No, not really. Someone using their insurance will have a prescription with the diagnosis. You can do what work you feel is needed as long as you can chart what you do and show that what you do is working. Use the insurance as a way to build a regular cash client who received maintenance massage therapy regularly.
Q. What will they pay per session? Health insurance won’t pay much so it isn’t worth taking.
A. Finding out what an insurance company will pay and if they pay is up to you. Start with asking your local massage therapists, look for a Facebook group of local therapists, ask your local AMTA Chapter representatives, or start your own group. In most states, car accident insurance will pay the full amount that you bill. Workers Comp has a fee schedule.
With health insurance plans, the pay can be an issue. In WA State though we were paid very well ( $80- $120 per hour) for about 15 years until the carriers started reducing the allowable fees. The main issue is that the carriers set their fees based on a formula that includes the cost of the work being done in a session. This information should be provided by our professional associations but it has never been provided to my knowledge so they carriers use what information they have. You have to also remember that the client will come regularly like once or twice a week for a specific amount of time, filling your schedule and are likely to become a regular client after the case is closed or the benefits run out.
Q. Most people using their insurance don’t value massage. They are the first ones’ to not show up, show up late or are the most difficult to work with.
A. Just like your other clients, having policies in place will help you limit no shows and late arrivals. The client will have to pay this, not the insurance so it helps educate clients about the importance of sessions. Some clients will often try to push the boundaries of the insurance benefits and get maintenance massage which is usually not covered. This will help you in creating and enforcing your policies around taking insurance.
Q. The healthcare system is so broken. Why would we want to be a part of this?
A. Yes it is. But it is what we have. Taking insurance will also help with the gender and racial disparity in healthcare overall and in the massage profession. We should also be working on other things like how about a health insurance plan for Integrative Care providers that is fair. What is really broken is our associations who are not advocating enough on this issue. If you look at other professional associations like the Physical Therapy Association, they have a Political Action Committee and a team of billers, lawyers and others that advocate for them. We used to have some of that in WA State when we were first allowed to start billing health insurance that came from AMTA National and a strong WA Chapter that did have lawyers on retainer and a lobbyist and a team working on healthcare integration, , but the funding from AMTA National for that has stopped.
Q. Is the ability to bill insurance coming whether we want it or not…whether we are a part of it or not?
A. I have been watching this issue since my first edition of the Massage Insurance Billing Manual in 2005. At first my main goal in writing the book was to just share what I know. I had not intended to do anymore editions but in 2012, I saw that Affordable Healthcare Act come to be and thought for sure that the language would help to make this so. Our professional associations have not done anything to help make it so especially AMTA who claimed that 51% of their members did not want it to be covered. What about the other 49%?
Since then, many things have been happening that are pointing to massage therapy being more accepted by insurance, legislators, doctors and hospitals. The thing is that we are not at the table with the powers that be so that they will dictate benefits and coverage without us. Even though the system is broken, it is what it is….why not be at the table and create what we want in what ways we can rather than letting others dictate to us leaving the massage profession to react to the many challenges rather than work to create what WE want for the profession.
My current edition of the book Massage Insurance Billing Manual, just released in 2019 now covers the history of WA State and how we have had the ability to bill health insurance since about 2000 and the challenges we now face mainly because we have not had the support from our associations to help us with the many issues.
Q. What techniques or methods will I have to learn in order to be able to bill insurance? Will I have to learn Medical Massage?
A. There is no such thing as Medical Massage. What you will have to learn is how to assess clients conditions, work in a way that relieves pain and improves function (using any method you already know) and learning to chart what you do. You will need to understand critical thinking and learn about various conditions and how to work with them. You will need to keep up to date on research and understand Science Literacy.
Q. What do we need to do to get health insurance to cover massage therapy? What about getting massage therapy covered by Medicare and Medicaid?
A. We need strong advocates that will stand up for us in each state to create laws like we have here in WA State. We need national advocacy that will get us into Medicare and Medicaid. AMTA has been working on this on a national level with some Medicare Advantage Plans now paying for massage. Also the VA has accepted massage therapists and have created a job description for massage therapists which is a very big step in this process.