Insurance Massage

Why would insurance cover massage at all?

Well, why do people get massages? Relaxation, sure, but also for tangible reasons such as regaining range of motion after a joint injury or alleviating extreme muscle pain. Things that need to be taken care of by a healthcare professional – which is why insurance has a part in it.

I work with a variety of insurance companies. Not all massage therapists do this; usually just those working closely with a doctor or chiropractor. I’ve found, however, that not only does taking insurance benefit my practice, but I actually do enjoy it.

That isn’t to say that I like being on hold for 30 minutes every time I call the insurance company with a question, but the set-up has its advantages. The main benefit for me is that I don’t need to market directly to potential clients. When members want to find a provider, they search on their insurance’s website. My name and contact information come up; they call the clinic and schedule an appointment. Plenty of clients with minimal effort.

In return, I fill out extra paperwork (for billing and for establishing a “medical need” for continued care), and I have to abide by their (sometimes overbearing) rules. As a concrete example, one insurance company will only pay $45 maximum per massage (30% less than my normal cost), and I’m not allowed to bill the clients for the remainder. But this insurance company sends me, by far, the most amount of clients. Less pay per client, but more clients overall. It’s a trade-off worth taking.

And because clients are only responsible for a small amount of the cost (copay or coninsurance), they’re more willing – indeed, more able – to come in frequently. For my clients with acute pain or injuries (I have a lot of them), this is the difference between getting rid of the problem in two months and letting the problem linger for years.

Generally speaking, acute problems are the types of things one goes to the doctor for. That is, we have health insurance to protect ourselves against agonizing injuries or pain that restricts our daily life. But what happens when these problems are muscle related, when massage is the best answer? Should health insurance always cover these circumstances as well?

A client came to see me last month because of debilitating shoulder pain. I quickly determined that the cause was trigger points, and she needed to come to see me every week for treatment to be most effective. After a few sessions we were making progress, definitely heading in the right direction. But since her insurance didn’t cover massage, she was paying out of pocket for every treatment. The cost adds up; there’s no denying that.

Her insurance covered physical therapy, however. She found a PT who could do trigger point treatment, cancelled her massage and went there instead. I wasn’t angry with her, or even upset at losing a client. We both wanted her to get better, but at what (monetary) cost? Her coming to see me was better for my bottom line, sure, but that’s not why I’m a healthcare provider.

I’m not trying to argue that all massages are medical necessities. But if the physical therapist is doing the same thing that I’m doing, why should he be covered through insurance when I’m not? I know that massage therapy has decades of baggage and still struggles for legitimacy in the modern world, but the point is this: Licensed massage therapists are healthcare professionals. They should be under the same insurance umbrella as other healthcare professionals.

(The client in question returned to me a week later, after an unproductive “trigger point” session with the physical therapist. But I digress…)

Should all insurance cover massage?

Well, no. At least, not in our current multi-payer, private company layout. There are still plenty of insurance tiers, everything from the most basic, bare-bones coverage to the all inclusive, medical/dental/vision/anything you’ve ever dreamed of coverage. It would be silly of me to say that massage should be covered even when most services are not.

But if someone’s coverage includes rehabilitative/complementary care such as physical therapy or chiropractic, shouldn’t massage be included as well? I would say yes. But then I would immediately challenge my answer.

If all LMTs are healthcare professionals, can all massages be considered medical needs? What about massage in a spa setting? (And if these count, would spas need to start billing insurance?) What’s considered a medical need? Physical pain, sure, but what about stress? Non-clinical anxiety and depression?

There are so many types of massage; would insurance cover every single modality (e.g. Thai massage, deep tissue, polarities, etc)? Or would insurance companies decide which styles they considered “medically relevant”? Who would make that decision – some CEO who thinks he knows best? A group specially trained in examining massage research?

So many questions!

I know that this post is mostly rhetorical, bringing up a lot of points without solving any problems. But there are no easy answers. I think that it’s time for a serious discussion about the role of massage in healthcare, and I hope this post can shed some light on a few murky topics.

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