The Future of Insurance Coverage

I’ve written before about my frustrations with insurance companies. Sometimes they think that therapists who aren’t exclusively trained in massage therapy would be better at giving massages than those who are. Sometimes they don’t quite understand that “massage therapy” and “manipulative therapy” are two practically indistinguishable labels for the same process.

But I’ve also mentioned that there are big changes afoot when it comes to expanded insurance coverage. As I investigate and learn and write for my volunteer blog, I’m more knowledgable about the upcoming changes and more confident that these changes will actually, well, change things.

So let’s review!

The part of the Affordable Care Act that matters here is Section 2706, otherwise known as the Non-Discrimination Provision. This section states:

(a) Providers.–A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.

This provision is written to cover providers, not services. What does that mean? While the distinction may be subtle, it’s actually quite important. Many people already have insurance policies that cover massage (the service). But so often (as I’ve written about before), massage coverage does not mean that massage therapists are covered.

When this provision takes effect, however, any provider licensed to give massages (LMT, chiropractor, doctor, whoever) will be covered by insurance. See the difference?

[Side Note: As long as the ACA rolls out according to plan, this provision will take effect on January 1, 2014.]

That being said, this change doesn’t mean that everyone will suddenly receive insurance policies that loudly proclaim “YOU HAVE MASSAGE COVERAGE”. Some people will still have that; some still won’t. But – and here’s the other great news – if your primary care provider determines that massage is the best course of action (read: “medically necessary”), then the PCP can write a prescription for massage – and you can get that fulfilled with any provider who is licensed to give massages. Not just an osteopath. Not just a chiropractor. Massage therapists will be considered equals in the healthcare field.

The last piece of this puzzle is that, similar to the way things are now in Oregon and Washington, massage therapists (and other medical providers) will only be able to bill insurance companies if they’re credentialed with them. This means that LMTs won’t automatically be linked to insurance companies – they still have to fill out paperwork first in order to join each network. Indeed, there will be some who won’t want to make this change; many LMTs run thriving cash-only businesses, and don’t want to deal with the potential hassle of insurance. But for those who do depend on insurance coverage, or who want to make their services available to the greatest number of people in need, these changes will be invaluable.

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