Massage Insurance Billing in WA State

WA State MT have been able to bill health insurance for massage since around 2000 or so.  There was a law created in 1996 that the insurance companies fought for years until it was finally made into law by the US Supreme Court.  The law we have here is called the ‘Every Category Law’ which mandates that every insurance company needs to have massage therapists on their panel of providers and cover massage. Here is a little history on how massage got covered by insurance in WA.

Here is an overview of how billing works here:

  • We have to sign up and fill out a bunch of forms and become a contracted provider for the insurance companies.  Currently most of the lists are actually closed but I have heard that some can still get on if they work for others or in an office that has others who are on.  One list has been closed for probably over 5 years or more.  I think there is still one list that is open.
  • You have to sign a contract.  Fees are set by the insurance company and they can change them at any time. The contracts are detailed in what providers can do and can’t do and even in what they can say and can’t say.  They do tell you when they change them.  Yes they have dropped over the years, but they still pay what is  a reasonable fee to many.
  • Clients/Patients need a prescription for massage.  It needs to have the diagnosis and the treatment plan (how many sessions for how many weeks) and it usually needs to end within 3 months.  A new prescription is needed after that.  (That is what one insurance company requires specifically so I just changed all my cases to that to make it easier)
  • Massage needs to be medically necessary.  Every company has their own definition of that but in general massage needs to be for a condition or disease or problem that massage can show improvement for.  (You can see some samples from the different insurance companies on my clinic website.  That needs to be updated, I just realized but it will give you the idea!)
  • We have to do an intake on each client and get all their insurance information for billing.
  • They need to sign HIPAA forms that just say how we will use their personal information and how we will protect it.  You can get the forms online at www.sohnen-moe.com/forms
  • We need to do SOAP charts on each client showing improvement.
  • When the client is better, even if it is before the end of their prescription, the sessions are done.  Maintenance massage is not usually allowed.
  • There are one or two plans that do allow for preventative massage.
  • Massage therapists can use services like www.officeally.com which is a billing clearing house for free.  It allows the bills to be submitted to each insurance company electronically.  They also have a total practice management system that is free and they also have a system for taking credit cards through them.
  • Massage therapists have access to each insurance companies database online through www.onehealthport.com to check benefits and claims making it easy to verify coverage and benefits.
  • Most insurance companies pay within a few weeks of submitting the bills.  They have been sending checks with Explanations of Benefits.  They are moving toward direct deposit and getting the EOB’s online either through www.officeally.com or through the insurance companies website though onehealthport.com
  • Clients/Patients come once a week usually until they are better.
  • Most doctors ask for progress reports which is a good way to network with doctors and show them what massage is doing.
  • Clients/Patients will find you through the provider directory or will find you through your website so you need to have pages on insurance on your site. (That means you don’t have to do more marketing to get clients.  They find you!)
  • Clients will get better and move on or decide to come on a regular basis and pay cash later.
  • You will be talking to doctors and insurance companies so you need to know what you are talking about and doing

I personally see clients with back and neck pain, shoulder pain, knee pain, herniated discs, plantar fasciitis, carpal tunnel and just about any type of pain and things like fibromyalgia and headaches.  It does not cover massage for anxiety and depression which is interesting as the strongest research we have on what massage does is how massage does work for those conditions.

We are contracted providers with companies like Aetna, Cigna who are managed by a third party (Healthways Whole Health Pro), Regence Blue Shield, Premera Blue Cross, First Choice, Group Health and others.

Yes they do change things up a lot and you have to stay on top of everything.  You have to know what is covered and what the rules for billing are.  There are way fewer billing issues now with things being so automated but there are still headaches.  It is just a matter of staying informed.

See also:

Insurance Billing 101 for Massage Therapists – the Ebook/Book

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