Massage Therapy Insurance Reimbursement
Massage therapy is gaining respect in the healthcare community, and this brings perks. The American Massage Therapy Association reports that massage therapy is more likely to be reimbursed by healthcare insurance than it was five years in the past (https://www.amtamassage.org/career_guidance/detail/125).
Healthcare policies vary a good deal. Among the common requirements: that the treatment be provided for a specific health condition and that a medical practitioner write a prescription. Massage might, for example, be allowable as a pain prescription – the healthcare community is very interested in alternatives to narcotic drugs (See: Massage Therapy as an Alternative to Opiods).
Massage therapists should be aware that there is a geographic element to healthcare coverage. It’s not just a matter of a person’s diagnosis but where he or she lives.
Regional Health Insurance Trends
A recent study took a regional look at health insurance policies (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868896/). The researchers focused on northeastern states but included some carriers with a multi-state presence. They noted that massage enjoyed a greater presence in the Western states and that massage was more likely to be included as a benefit in the West.
A number of policies offered coverage for massage but with some limitations. In some cases, being credentialed as a massage therapist would not be enough. Some policies required massage therapists to seek pre-authorization.
It is common to place limits on number of visits and length of sessions. The carrier may state that the treatments must be part of a treatment plan made by a healthcare provider.
Some policies noted particular techniques. Among those commonly noted: manipulation, manual lymphatic drainage, and myofascial release.
Some carriers include massage therapy as part of an optional rider.
Plan providers may have their own group of in-network preferred providers.
Insurance Options in the Pacific Northwest
Washington State was an early leader in massage therapy insurance billing (https://amta-wa.org/page/insurance_billing?).
A search finds a number of Oregon and Washington health plan providers touting their massage/ CAM benefits and plenty of massage therapy practitioners and groups citing their status as preferred providers. Some note a lengthy list of insurers.
Massage Discounts Offered through Healthcare Plans
Some insurance providers offer their members discounts for massage therapy. The American Massage Therapy Association has described how this scenario works. The company contracts with specific massage therapists. Typical practitioner requirements include working in a clinical setting and being covered by liability insurance. The healthcare in essence markets the massage therapist.
A health care plan, notably, may offer massage therapy as a reimbursable service and also as a discounted service. Kaiser Permanente, for example, notes that plans typically include massage therapy when it’s determined by a physician to be medically necessary (https://wa.kaiserpermanente.org/html/public/services/alternative). Members may utilize providers from the Complementary Choices Discount Plan when the service they seek doesn’t meet the reimbursement criteria or they have used up their allowable visits. Kaiser Permanente informs members that the massage therapists listed have been vetted twice: They’ve met the organization’s standards as well as those of the state licensing board.
Reimbursement from Other Payers
When massage is prescribed as treatment for an injury, it may be covered by other types of insurance. Individuals who are involved in motor vehicle accidents may receive their reimbursement through auto insurance.
Individuals who have been injured at work sometimes receive therapeutic massage through worker’s compensation.
The particulars will vary by location and claimant circumstance. State agencies are a resource. The State of Oregon, for example, has published a provider handbook for massage therapists who treat worker’s compensation claimants who are not enrolled in Managed Care Organizations (https://wcd.oregon.gov/medical/provider-training/handbooks/Pages/massage-therapists.aspx). In order to be panel compensated for treatment provided to a workers compensation claimant who was enrolled in an MCO, an Oregon massage therapist would need to be an MCO-panel provider. Kaiser Permanente On-The-Job is among the Oregon MCOs.
Pennsylvanians recently won a victory with regard to massage therapy benefits provided through worker’s compensation (https://www.propertycasualty360.com/2018/01/09/massage-therapy-is-it-a-covered-workers-comp-medic/?slreturn=20181120234110).
Becoming a Preferred Provider
Multiple organizations contract with WholeHealth Networks for assistance in putting together their CAM networks (https://www.wholehealthpro.com/NetworkPrograms#camNetwork). Massage therapists who are interested in going through the process can find applications for quite a few organizations. Other application materials may be found through links from insurance providers.
Paperwork requirements can be high. AMTA has provided resources for massage therapists who accept insurance reimbursement or are considering doing so (https://www.amtamassage.org/career_guidance/type/2).
Envisioning the Future
Practitioners will want to watch for new developments. It can take more research to put a therapy in the evidence-based category than it does to convince practitioners and patients alike that there is some benefit. Even with conventional healthcare, there can be changes from year to year in what is considered experimental and what is considered evidence-based (and more likely to be covered).
It’s not just a matter of waiting for the clinical trials. As massage gains wider acceptance as a healthcare treatment, massage therapy organizations are engaged in advocacy. AMTA has provided information about dialoguing with professionals from the insurance industry to the legislature about the efficacy of massage (https://www.amtamassage.org/career_guidance/detail/220?typeId=2). Patients are also learning how to ask their healthcare providers for a massage prescription. Wexner Medical Center has provided tips for patients who want to dialogue with their doctors about massage therapy prescription (https://wexnermedical.osu.edu/blog/how-to-get-medical-insurance-to-cover-massage-therapy).
On a positive note, it’s not a fringe group who wants to see massage included as an insurance benefit; it may well be the majority. According to an AMTA fact sheet, 64% of adults would like to see their insurance carrier provide massage therapy as a benefit (https://www.amtamassage.org/infocenter/economic_industry-fact-sheet.html). And many people are talking with their healthcare providers about massage.
A large group of attorney generals – representing well over half the country – wrote a letter in late 2017 urging coverage of various therapies that could be used as alternatives to opioids (https://imconsortium.org/resourcesjournal/moving-beyond-medications/). Massage therapy was among those that received a mention.