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Does Insurance Cover Massage Therapy?

Written by: bodywellinc | June 3, 2010 12:40 PM in Massage Therapists | 12343 views | Tags: workmans comp massage , Florida massage through insurance , accident injury , PIP benefits , Deep Muscle Massage , Medical Massage Therapists , Mobile Massage Therapists , Myofascial Release Massage Therapy , Trigger Point Massage Therapy , massage through insurance , auto insurance massage , insurance massage benefits , workers compensation claims benefits , work injury , auto injury , car injury , injury rehab , alternative therapy , massage clinic , auto injury claim , accident claim

"Does my insurance cover massage therapy?"  is a question that many people ask. Due to many variables and kinds of insurance, the answer is not a straightforward one, but I will try to answer this question in some general and simple to understand terms.

First it should be pointed out that except for federal government programs like Medicare and the Office of Worker's Compensation, policies and benefits can vary state by state. For example, Blue Cross Blue Shield (BCBS) of Florida may not cover some of the same services as Blue Cross Blue Shield of Michigan.

Second, it's important to understand that regardless of the insurance, generally the massage needs to be deemed to be "medically necessary" and prescribed by a medical doctor before it will be covered. In other words, unless you have a special supplemental holistic wellness plan that allows a few massages a year, you can not receive massage through your insurance for general prevention or wellness and health maintenance reasons.

Next and perhaps most relevant is that it depends on what type of insurance we're talking about. Some provide excellent benefits and others none at all. There are perhaps three major categories of insurance that you would be most likely to be asking about.

1. Major Medical Insurance (BCBS, United Health Care, Humana, etc.)

When it comes to the Major Medical plans, generally speaking it is very difficult to get massage therapy covered, particularly when performed by a Licensed Massage Therapist (LMT). In fact, most of these companies do not allow LMTs to be the "provider of services" so the billing must be done through a physician or other recognized provider. Sometimes the closest thing might be having some massage-like procedures performed by a Licensed Physical Therapist (LPT). Most LPTs do not want to spend much time performing manual manipulation and are not likely to treat the body holistically as a LMT would be more likely to do. These insurance companies seem to be constantly maneuvering to disallow as many massage therapy services as possible. Worth noting also is that any services performed by an LMT through these plans needs to occur at a doctor's office under on-premises supervision.

2. Automobile Insurance (Geico, Progressive, Allstate, State Farm, Nationwide, etc.) or other kinds of accidental injury policies that may be carried by a large employer (Travelers is a large one).

With respect to Auto Insurance and massage, the good news is that generally the available benefits are excellent! I honestly can't explain why these companies have such starkly different policies from the Major Medical plans, but most of these companies readily recognize LMTs as "Providers of Services" who are able to directly bill for prescribed and authorized services. Generally, as long as benefits are available in your policy through Personal Injury Protection (PIP) benefits or Med Pay (medical payments benefits), you will be able to utilize massage therapy as a means to treat injuries. Everyone's policy is different, so the amount of benefits will vary. Some states such as Florida require "no-fault" PIP benefits for every driver. This is highly beneficial for the consumer, because it means that no matter who was at fault in the accident, medical benefits (in the case of Florida at least $10,000) are available to treat any injuries. In other cases, it may depend on what benefits are available through the other party's insurance.

One final note about Auto Insurance covered massage is that this is generally allowed to occur in the convenience of a patient's residence, as opposed to having to occur in a medical office. Many people find that they can obtain all of their prescribed therapy much more easily when it can be done virtually any time right in their home. Many massage therapists are available for in-home visits.

Other kinds of accidents such as those sustained at work may be covered by a private accidental injury and liability policy. These operate in a similar fashion to the auto insurance policies in that LMTs may bill directly and provide in home services, usually without too many complications as long as everything is administered correctly by the provider.

3. Government run programs as mentioned above.

This is an interesting one, because even though Medicare and Workers Compensation are both administered by the federal government, both view massage in completely opposite ways.

With Medicare, they have all but completely ruled out any hands-on manipulation type services being performed by massage therapists, and if they do pay it is very little. They seem to be trying to relegate LMTs to applying hot and cold packs, putting people in hydrotherapy tubs and other technical types of things that don't really utilize the expertise of LMTs.

On the other hand, Workers Compensation absolutely does allow LMTs to bill for prescribed services to treat injured workers. It is a little complicated to become registered as a provider for this program, but once that is cleared usually the therapy can proceed.

I hope that this has helped to clarify the question of what kinds of insurance policies cover therapeutic massage. If you feel that you have a medical condition that could be helped by massage and feel that you may have benefits available, I would urge you to find a reputable provider in your area who may be able to give you more specific information about what your policy benefits allow.

In Health,

Daniel Melmed

Owner, Body Well Massage Professionals

 

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