I actually wrote this over the summer but I apparently saved it as a draft and never published it so it's appearing as a recent blog; it actually isn't very new but I hope you find it somewhat informative.
I am often asked, "Do you take insurance?" Some insurance plans do pay for massage but WHO they pay is what it comes down to.
Before I begin let me just say that I do accept insurance for auto accident claims, pending verification. If you're injured in an accident and your insurance will cover massage I can probably bill them for you. I had to put the "probably" in there because even when some plans pay for it they are particular about how they do it. You do have to have specific forms completed by your primary care provider that they don't have in their office -- I have to send them, steps need to be taken with your insurance company before I can begin, and you will need to be willing to have a credit card on file in case for some reason your insurance company fails to reimburse me. It can happen.
Most auto insurance companies recognize massage as a health care service and many health/medical insurance companies recognize it also, but they differ when it comes to whether they recognize a massage therapist as a provider for that service. Yes, apparently massage therapists are not always considered legitimate providers of massage therapy. So what it comes down to is not whether the massage therapist will take your insurance, but who will reimburse a massage therapist and who won't -- most auto insurances will, most health/medical insurances will not. That is, unless, you live in Florida or Washington state. In those states, the same health care companies that deny direct reimbursement to licensed massage therapists in 48 other states WILL directly reimburse licensed massage therapists. In Maine, the insurance companies will reimburse doctors' offices and hospitals and they, in turn, can pay their employees but many health/medical insurances will not knowingly reimburse a massage therapist directly. As a matter of fact, more and more insurance companies have been demanding reimbursement from massage therapists who were not authorized to receive payments from them. Perhaps some do reimburse directly but many do not. They will, however, consider directly reimbursing YOU, their customer. What you do is pay for the massage yourself and then submit a "superbill" for your reimbursement.
Now, you may be a bit confused because you'll hear of other massage therapists "accepting" your insurance directly, nevermind this doctor stuff. To the best of my knowledge -- and someone in Maine PLEASE let me know if I'm mistaken -- they are not "accepting" your insurance at all. What has been done in the past and what some insurance companies have stopped doing is that the massage therapist will sign an agreement with the insurance company that allows the therapist to be included in their list of providers; HOWEVER, the insurance company has absolutely nothing to do with the massage therapist. They never see a bill from the therapist. They don't even know that you've seen the therapist. They never pay the therapist (and if they did they will at some point come back to collect their money when they find out the practitioner is not a doctor and guess who that therapist might then turn to in order to collect payment? That would be you, my friend. You, the client.). What really happens is that the massage therapist agrees to provide you, the insurance company's customer, with a discount in exchange for being listed in that book/pamphlet. That's it. It's an advertisement. Rather than the therapist paying the insurance company for an ad in their provider listing -- which is probably unlawful -- the therapist takes a cut in pay for the ad, with the hope of receiving a kickback in the form of paying customers. As well intentioned as it may be it can be misleading to the consumer who thinks the therapist is somehow associated with the insurance company. I have seen ads where massage therapists say they can directly bill your insurance but aside from auto coverage or workers' compensation I don't know how this is, when I've spoken with most insurance companies and they all have said the same thing, "We do not contract with massage therapists". If someone out there has managed to get a different response I'd love to know.
Here's the potential problem with directly billing insurance. Insurance is great when you have a medical issue that needs to be addressed. For example, if you have an injury and want or need massage as part of your rehabilitation, insurance that covers massage is a WONDERFUL thing to have. But if you're coming in for a massage as part of your wellness routine with no specific health or medical goal in mind that your doctor has recommended for you, you might want to think again about whether you want all massage services to be covered by insurance. If the other 48 states followed suit with the first two, there's a big debate about whether it's actually beneficial. Why? Because insurance companies are a business. A business is concerned with its bottom line. Insurance will dictate every little detail about your sessions -- how many you can have, how much they'll actually pay the therapist (and when they don't pay it all & the therapist loses the dispute, the therapist will charge you for the difference; if it's rejected the therapist will charge you in full), how many minutes long it can be, where on your body you can receive massage, and which parts of your body are covered as an option for therapy at all (You know that little muscle there in your eyelid that keeps driving you crazy and you're afraid that sometimes people think you're winking at them because it won't stop flipping out? It might not be covered, that's all I'm saying.). It's all in the medical coding used to write the bill, which has to be done on a special piece of paper in a very special way so the person who looks at the bill can decipher every little aspect of your visit and decide which part is reimbursable and which part is not. For example, if you had a headache and the massage therapist found the source of the muscle tension (causing your headache) to be near your shoulder blade, the insurance company may very well deny payment for massage to anywhere other than the head -- because it was a "head" ache, not a "shoulder blade" ache.
I do have to say that some companies WILL reimburse YOU if you get a massage and it often has to accompany a prescription from your doctor with a legitimate reason for you to receive the therapy. This is absolutely WONDERFUL! Don't confuse this as your therapist "accepting" insurance though. The therapist has nothing to do with your insurance here either. This is only between you and your insurance company but by far, in my opinion, the best way to go. Yes, your claim can still be denied and no, you can not get your money back from the massage therapist if that happens but this is why you call the company in advance and get the authorization yourself. If you can get your hands on a plan that will give you this option YIPPEE! It's great for everyone involved! This is a roundabout way for companies to FULLY cover the cost of your massages without having to mess around with all those strings attached. Who benefits here? The massage therapist gets paid in full. The cost of business stays low because there's no need for an increase in overhead. You pay up front but get fully reimbursed by the company after sending them a receipt. They have a happy customer and work within their budget. Seems to me everyone benefits from that plan.
