What Your Health Insurance Thinks About Health Care

Shortly after my last blog post, I wrote an email to Providence asking them for an explanation of their policies – specifically, why massage therapy is covered when done by a chiropractor but not by a massage therapist. Surprisingly enough, I received a reply.

It begins:

Providence Health Plan made the business decision not to cover massage therapy as part of the basic alternative care rider. We do have some larger employer groups that have developed custom benefit designs for their employees that include massage therapy.

Well, this gets right to the issue. The decision to cover or not to cover massage is a business decision. Not a medical decision. And because covering massage would cost too much money, it makes sense financially to leave it out of the alternative care package.

And why would it cost so much more to cover massage? Because – gasp! – people would actually utilize the service. Oh no! An insurance benefit that might actually be useful to a large number of people! We can’t have that!

As to why chiropractors can bill for massage, but I can’t:

We have discovered over the past year that many chiropractors are abusing the massage therapy service that is within their scope of practice. We have developed a new policy which will correct the misconception that members can get massage therapy services from a chiropractor. I have attached the policy to this email.

Ah, so it’s not massage therapists who are being singled out, just massage therapy.

So I checked out the attached policy:

Massage therapy may be used as an adjunct service to manipulation, especially when there is documented muscle tightness, swelling, and/or motion limitation due to spasticity or guarding. However, there is rarely a medical necessity for a one-hour, full-body massage. Typically, massage therapy (97124) is a targeted procedure to address a specific condition with the intent to provide relaxation of specific muscles or to reduce swelling related to the target condition. This is generally accomplished with one unit of message (up to 15 minutes).

Let’s break this down, shall we?

  • Massage therapy may be used as an adjunct service to manipulation, especially when there is documented muscle tightness, swelling, and/or motion limitation due to spasticity or guarding. Ok, yes, this is true. Massage is really good at warming and loosening up the muscles in order for an adjustment to be effective. Not that massage is exclusively good at being an accessory to chiropractic, but sure, they work great together.
  • However, there is rarely a medical necessity for a one-hour, full-body massage. Uhh… come again? By medical necessity, do you mean that there’s no proof that a one hour massage might… provide relief from pain during cancer treatment*? Lower anxiety? Improve immune function? Decrease inflammation? Lower depression scores? (And not to mention all the pain relief that massage provides without the assistance of a spinal adjustment.) Also, the idea that just because a massage is long means that it’s unfocused (i.e., a full body massage) is completely unfounded. More than half of my clients on any given week just want me to work on their neck, shoulders, and upper back. Hell, I’ve spent a whole hour just working on someone’s left leg.

And wait… wasn’t the choice not to cover massage specifically a “business” decision? Why try to dress it up with medical misinformation? (answer: because “it’s not cost effective to provide effective health care” didn’t make it past the focus groups.)

  • Typically, massage therapy is a targeted procedure to address a specific condition with the intent to provide relaxation of specific muscles or to reduce swelling related to the target condition. Yep, this is true. As I said above, about 50% of my massages every week are focused on a specific problem area.
  • This is generally accomplished with one unit of message (up to 15 minutes). I know that the committee that wrote this isn’t made up of massage therapists, but this makes me doubt that any of them have ever had a massage at all. I can easily spend an hour working on a single area in order to reduce swelling and break down adhesions, and even then I haven’t achieved everything within just one session.

To anyone who’s had a massage before, what’s your opinion? Do you think that, sure, the first 15 minutes of a massage session might be useful, but the remaining time is just for fun?

Right. Try telling that to some of my trigger point clients.

But wait, there’s more! In my email, I had asked about what I should tell prospective clients when they contact me via Providence. Clients know that their insurance policy has alternative care benefits, which they assume covers massage. They search on the Providence website for covered providers, and my name appears. They call to schedule an appointment, but I have to explain to them that their benefits don’t actually extend to massage. So, I asked, what reason can I give them?

Regarding your concern that because you are contracted with Providence (through ASH) members feel that your services are covered; members need to take more accountability regarding their health benefits. They can’t assume that because a provider is listed in our directory all services that the provider preforms [sic] are covered under their benefit package. That would be like looking up a plastic surgeon in our directory and assuming all of the services the provider does are going to be covered.

This just outlines how little the insurance companies thinks of their members. It isn’t the company’s job to make it clear what or who is covered. I love the example I’m given as to why, duh, members shouldn’t assume that my massages are covered by their plans, assuming that “because a provider is listed in our directory, all services that the provider preforms [sic] are covered under their benefit package”.

Except, you know, massage therapy is the only service I perform. That’s it. If someone isn’t covered for massage and they search for covered providers on the Providence website and my name comes up (this is what routinely happens), I still won’t have any covered services to offer the member. Because all I do is massage. And massage isn’t covered. That seems a little faulty.

The end of the email offers me a solution:

You can always direct members back to their human resources department if they are upset about their benefit design. The employer is the one that makes the decision to benefits packages for employees. Many employers are looking for ways to cut costs and just adding massage therapy to the benefit package may be too much for the employer to cover for their employees.

See? It isn’t the insurance companies fault that massage isn’t provided. It’s the employers. If employers weren’t so concerned about cutting costs, they could easily have added massage coverage… to the Alternative Care package that they already pay for. The Alternative Care package that doesn’t include massage because, as declared above, a one-hour massage is “medically necessary” only on very rare occasions.

I don’t quite know what to do with this email. I’m glad they replied – previously I could only hypothesize about their level of stupidity and greed; now I have proof – but more and more I feel like I’m just yelling at a brick wall. Sigh.

* To be fair, some of the studies I cite had shorter intervals of massage for research purposes, but the goals of these studies were not about massage-in-relation-to-adjustments. Chiropractors would be out of their scope if they were giving 15 minute massages to alleviate depression.

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