Getting health insurance to cover massage therapy

One of the next steps in the future of the massage profession will be getting more health insurance companies in the US to pay for massage therapy.  It is already happening plan by plan in various states and some companies are setting up alternative health benefits for their employees and allowing a yearly benefit for massage therapy.

In WA State, where I live and do massage, we have been able to bill health insurance companies since around 2000.  It was after a long battle between the insurance commissioners office and the insurance companies.  In April of 1993 the WA State legislature adopted the ‘every category of provider law’ (RCW 48.43.045)  mandate as part of the 1993 Health Care reform Act in WA that was created by the insurance commissioner at the time – Deborah Senn.  The statute was supposed to go into effect in Jan 1996, but the insurance carriers filed a lawsuit to have a court decide the correct interpretation of the law.

In Jan. 1999, The US Supreme Court finally ended all of the court battles and the ‘every category of provider’ law allowed massage therapists, acupuncturists and Naturopathic Doctors to become contracted providers with health insurance companies and get paid for medically necessary massage.

Deborah Senn, as I later found out after hearing her speak at the Massage Therapy Foundation Research Conference in 2010 in Seattle, created the mandate because she was a big believer in massage and got massage herself from a very politically active massage therapist – Lori Belinski (who is now actually working for the WA State Chiropractic Association).  Together they stood up for the profession and fought many years to get the law enacted.

That is all it took folks!  It didn’t take having better education standards.  It didn’t take having more research to show how massage works.  It didn’t take anything else but having a savvy insurance commissioner take a stand for the massage profession.

You can learn more about how to bill insurance in my book Insurance Billing 101 for Massage Therapists .

So how it works now in WA State, is that massage therapists who are already providers with the insurance companies can bill for injuries and conditions for massage.  The benefits usually read something like :

Massage therapy may be considered medically necessary when performed to meet the functional needs of a patient who suffers from physical impairment due to disease, trauma, congenital anomalies, or prior therapeutic intervention. Maintenance programs are considered not medically necessary.

There is one problem though.  Currently, most (if not all) of the insurance companies have closed their provider lists making it impossible to get on the provider list, so new massage therapists right out of school can not apply or get on the lists.  They say that the reasons are that there enough massage therapists to provide care.

But those massage therapists who are on the provider lists are able to bill health care insurance like Aetna, Regence Blue Shield and Premera Blue Cross, Group Health and First Choice Health and all of the insurance companies.

Yes there are still many downsides to billing insurance such as not being able to get on provider lists and also having benefits for massage reduced and allowable fees reduced.  The other side is that many people who are hurt or injured or in pain and who might otherwise not ever seek massage as a part of their medical care are able to get regular weekly or twice a week massages (depending on the prescription) and many doctors are seeing how massage can help with things such as carpal tunnel, back pain and other injuries that may have required surgery.  Well that is another one of the things – many doctors still do not know that massage can help reduce the possibility that a patient/client may have to get surgery.

Deborah Senn also spoke of this at the conference saying that the biggest challenge in getting the insurance companies to accept massage and acupuncture – the insurance companies thought that they would have to be paying $20,000 for the surgery (or whatever the cost – I am just making that up for example) and then another $1-2,000 for the massage therapy.  They did not realize that it could be saving them money.

Currently in my personal practice, I still do not get that many referrals from doctors for things like carpal tunnel and herniated discs.  Most of the prescriptions are for people with back and neck pain and occasional pulled muscles.  There is still more work to be done in educating doctors about massage, as well as insurance companies.

So if you are interested in getting massage covered in your state – start with your insurance commissioner.  Then start looking at the Affordable Care Act and find out what your state is doing.  There is a chance that the ACA could bring many opportunities for massage to be covered on health insurance.  If you do not know what is going on in your state you should start with contacting your local AMTA chapter.  If they don’t have any information, they need to start a committee to start working on it.

Yes I know, there are many of you who don’t want the headaches of billing or don’t want to jump into the arena with insurance companies and medical professionals who would often rather use drugs and pay for drugs and that also are not about health but are about money.  Yes it is a very different world than most massage professionals who are all about caring and helping.  You can be a part of the medical profession and still not buy into ‘their’ world.  You can stay true to being a massage therapist and preserving the art of massage and combining it with the medical profession.  It will require getting much needed support from your fellow massage therapists in the way of peer groups and supervision.  It will require you to really keep up on your self care and not get drained from billing insurance.  It will require that you set and keep boundaries more than ever and learn to take cases that support you rather than drain you.  It can be done.