Does Insurance Pay For Massage?
How to take full advantage of your insurance benefits
Catherine Nelson, LMT, CST, CKTS
Insurance coverage has come a long way in the nearly twenty years I've been in practice. In that time, more and more "alternative" therapies have been added to standard health coverage. Services like chiropractic, acupuncture, and more recently, massage therapy are more widely covered than ever before.
Resource: Does Insurance Cover Massage? (Video)
Types of Coverage
Most people assume their insurance does not cover massage therapy. That could be true, but often when patients have called and inquired about their coverage, many of them have been surprised to find out they do have some coverage.
The most traditional idea of "insurance coverage" is an in-network massage therapist who will bill your insurance company directly for payment. You may or may not have a copay due to the therapist at the time of service. This arrangement is very similar to the way it works with your doctor, or perhaps your chiropractor.
It's always worth the time and effort to call your insurance company and learn if you have this type of coverage.
HSA and FSA Money
Health Savings Account (HSA) and Flexible Spending Account (FSA) money can be used to pay for massage therapy regardless of your insurance coverage. If you have one of these accounts, you probably plan to use it every year for dental and eye care, as well as doctor copays and any medications you take.
But have you set aside any money for your massage care? If you haven't, you can plan to do so for the next enrollment period. This will allow you to plan for regular massage care with money set aside for the purpose, rather than trying to find the money each time you need body work.
Prescription or Referral
The HSA and FSA accounts work differently, so you need to understand which type you have and the rules for using the money.
In general, no prescription or referral is needed to use HSA money. And in general, a prescription or referral is usually needed to use FSA money. There are always exceptions, so read the information you were sent regarding your account or call to ask these questions.
Obtaining a prescription or referral is typically very simple, and often people are not required to have a doctor's appointment for it. Don't hesitate to call your doctor to ask for one simply because you're afraid he or she will make you come in for an appointment first, especially if you've been seen fairly recently. In most cases, patients tell me a simple phone call or email was all it took for the doctor to write the required documentation.
Once you have the documentation required, you'll need to send that to your FSA or insurance company for them to authorize you to spend the money for massage. This does take a little bit of planning ahead, so be sure to start this process as soon as possible to avoid any delays in your care.
The HSA and FSA accounts handle gratuity differently. In general, the HSA account will allow you to include gratuity (tip) for the massage service. And in general, the FSA account will not allow it.
Again, this is a generalization and there are exceptions to the rule. If you would like to use your HSA or FSA money to include gratuity for your therapist, you will need to reference the account information you were provided or call to confirm you're able to do so. Otherwise, you'll be able to use that account to pay for the service and cover the gratuity yourself by cash or debit card.
The most overlooked coverage is employer benefits. People assume that their insurance coverage doesn't include massage therapy, and they also assume their employer provides no additional benefits. This is often false.
Separate from insurance coverage, lots of companies and organizations provide their employees various perks and benefits for self-care each month or year. Most of these types of perks go unclaimed, which is just such a waste.
If you're not familiar with the benefits or perks your employer might offer, it is often worth it to contact HR and ask some questions. You might be surprised to find they offer reimbursement for such things as chiropractic care, acupuncture, or massage therapy.
Local Employer Benefits
In our area, the City of Fort Collins and Larimer County offer exceptional self-care benefits. I have heard the City of Loveland offers similar benefits. With these benefits, the patient must pay out of pocket and submit documentation to HR for reimbursement. But that's worth the effort, because the benefit includes hundreds of dollars a year for things like massage therapy, and those patients are reimbursed in full.
If you are a city or county employee in our area and you are not receiving the bodywork you need on a regular basis, I strongly encourage you to begin taking advantage of this benefit today.
Worker's compensation is slightly different than the other types of coverage we've been talking about, but I want to note it here. This is one type of insurance that we will bill directly.
If you are injured on the job and would prefer to have massage therapy as part of your recovery process, that is available to you. You may have to mention it to the worker's comp doctor, and in some cases you may have to demand it, but the doctor can refer you to have massage therapy. Of course, I would strongly encourage you to do this, because injury massage will help you recover so much faster and with so much better results.
The work comp doctor will likely refer you to the massage therapist his clinic typically works with, but that is not required. You can ask that your referral be sent to the massage therapist you are established with. For example, over the years, my patients that have been injured on the job have requested their referrals be sent to me, and I have treated their injuries and billed their worker's compensation.
So if you become injured on the job, advocate for yourself to have massage therapy as part of your recovery. Not only will you get better much faster, you'll also see better results. And ask that your referral be sent to Del Sol so that you can be treated by the massage therapist you're already established with.
When I receive your work comp referral, I take care of everything from communicating with the insurance company to billing. No out-of-pocket cost is required of you. This makes it easy for you to receive the high quality of care you're accustomed to and focus on healing.
How to Use Your Benefits
The first step is to call your insurance provider and ask detailed questions about your benefits. It may also be wise to call your HR department and ask about employer benefits that may be available to you.
Once you learn you have benefits, ask detailed questions about how to use them. What does the insurance company require? Do they need a prescription from your doctor or a referral? Do they need a superbill from the massage therapist? Is there a reimbursement form you need to fill out and submit? Will the therapist need to sign that form?
Ask some questions, plan ahead, and take full advantage of the insurance and employer benefits you pay for.
Catherine Nelson, LMT, CST, CKTS, is a long-time massage therapist with a long and varied background in Western medicine. She specializes in CranioSacral Therapy for PTSD and anxiety, medical massage therapy for injury rehabilitation, and sports massage therapy for all phases of training and competition. She can be reached directly at Catherine@DelSolCommunityWellness.com.
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