Massage Coverage Increasingly Common
Health insurance coverage that pays for massage therapy is more common now than it was even five years ago. If an insurance company includes massage therapy as a benefit, sometimes the policy specifies that massage must be provided by a physician, a chiropractor, or a physical therapist. Insurance companies that cover massage therapy as a benefit, and designate that it may be provided by a massage therapist, establish rules that the massage therapist must follow. If the massage therapist does not follow the rules specified by the insurance company, he or she may be declared ineligible to receive reimbursement.
Types of Coverage
When an insurance company includes massage as a benefit, it might do so through different approaches:
- In one approach, insurance enrollees have access to a list of massage therapists who agree to accept a discounted rate. The massage therapist signs a contract with the insurance company, which specifies the details of eligibility. For instance, the contract could state the massage therapy fee, it could state that the massage therapist must work in a clinical setting (not in a home-based practice), and that the massage therapist must carry specified levels of professional liability insurance. In return for the massage therapist meeting these criteria, the insurance company markets the massage therapist's name to its enrollees. As with any contract, it's a good idea to have an attorney review it before you sign.
- Some insurance companies offer a wellness benefit, and companies that purchase this benefit may offer their members access to massage therapists who have qualified as "preferred providers." This is referred to as an "in-network" provider. Usually, the insurance company limits the conditions that the massage therapist may bill for and the type of massage modality that may be used. The requirements for a preferred provider are usually quite stringent. Clients must be referred by their Primary Care Provider.
The main difference between the two types of contracts is that preferred providers must accept any client who is covered by the plan and referred to them. In the case of preferred providers, the massage therapist may not bill the client for the difference between the covered benefit and the massage therapist's regular rate. In the case of the discount plan, whether the massage therapist can charge the client for the difference depends on the contract negotiated with the insurance provider.