Insurance Coverage for Massage Therapy by jolinmilioncherie


									                               Insurance Coverage
                               for Massage Therapy
                                         by Clark Dougherty, L.M.T.

       eople frequently ask me, “Will    answer for this is to check your               Marion County’s largest employer
       my insurance pay for massage      insurance information booklet or            does cover medically necessary
       therapy?”                         online service to determine if massage      massage therapy. However, the
    Before I answer, another question    therapy is a covered expense.               county’s largest manufacturer does not.
must be asked. “Do you mean,                                                             It depends on what the insurer
PIP from an auto accident, or                                                            and insured company negotiate
Worker’s Compensation coverage                                                           for covered services. Please note
from an existing claim, or                                                               that physical therapy and massage
employer group insurance or                                                              therapy are two different medical
private medical insurance, or                                                            services. A prescription written for
Medicare?” If your massage                                                               physical therapy will not be
therapist will create proper                                                             honored by a massage therapist,
medical records, coordinate                                                              and vice versa.
therapy with your medical service                                                            Usually, an annual deductible
provider and directly bill the                                                           must be paid by the individual
insurer, then five answers are                                                           before insurance will reimburse
possible:                                                                                either the individual or the
                                                                                         medical service provider.
     1. PIP, or Personal Injury
Protection. PIP is required for all                                                            4. Private Medical Insurance.
auto insurance written in Florida.                                                         This is just what it sounds like:
If you obtain a massage therapy                                                            medical service coverage bought
prescription from the treating                                                             by an individual or family. Just as
physician for the auto accident,                                                           for employer group insurance,
PIP will typically pay 80% to                                                              check your insurance information
100% of charges for massage                                                                booklet or online service to
therapy. The percentage depends                                                            determine if massage therapy is a
on the individual policy. It is                                                            covered expense. If you get a
always best to consult with the                                                            prescription from an authorized
adjuster assigned an auto accident                                                         medical professional including
case to determine both coverage                                                            your primary care provider or
and reimbursement rate for the                                                             chiropractor, and massage therapy
medical services provided.                    If you get a prescription from an      is included as a covered service, it is
                                         authorized medical professional             eligible for reimbursement.
     2. Worker’s Compensation. This is   including your primary care provider             Blue Cross/Blue Shield usually offers
a form of protection for work-related    or chiropractor, and massage therapy is     massage therapy as part of their covered
injuries. If you obtain a massage        included as a covered service, it is        services. However, they frequently set
therapy prescription from the treating   eligible for reimbursement.                 a low maximum benefit per calendar
physician, and if you advise and get          Blue Cross/Blue Shield is a prime      year on non-traditional medical
approval from the “WorkComp”             example of group insurance. They will       services such as physical therapy,
provider, typically 80% to 100% of       have established a reimbursement            chiropractic or massage therapy. Check
massage therapy charges will be          amount to pay for a specific medical        your individual policy for coverage
covered. It is always best to consult    service. Any charges beyond the             and for maximum benefits limitations.
with the “WorkComp” carrier to verify    reimbursement amount will be borne          United Healthcare typically does not
coverage and rates for massage therapy   by the individual. Usually a co-            cover massage therapy.
services rendered.                       payment amount per visit must be paid            As with employer/group insurance,
                                         by the patient/client prior to services.    the insurer will have established a reim-
    3. Employer Group Insurance. This    This is typical of all medical service      bursement amount to pay for a specific
is medical insurance provided by your    visits, whether to your doctor, dentist,    medical service, any charges beyond the
employer or by an association of         chiropractor, hospital, outpatient clinic   reimbursement amount will be borne by
individuals in a “group.” The best       or physical therapist.                      the individual, and a co-payment
amount per visit usually must be paid by       massage therapy will be included as a          your massage therapist whether he or
the individual prior to services.              covered service. For now, though, if           she is capable of and willing to provide
                                               you are 65 or older you will not               the extra effort insurance billing requires.
     5. Medicare. Medicare is the              receive reimbursement for massage              And then, enjoy the benefits of massage
national medical services ”insurance”          therapy unless you have a private              therapy in your everyday life.
for retirees age 65 and older. Currently,      insurance policy that isn’t connected to
massage therapy isn’t covered by               Medicare coverage and your private             Clark Dougherty is a Licensed Massage
Medicare. All secondary insurers who           policy specifically lists massage              Therapist (MA 27082) and has operated
sell supplemental Medicare policies            therapy as a covered expense.                  his Therapeutic Massage Clinic
use the same tactic for denying                                                               (MM9718, insurance accepted) for 10
massage therapy to Medicare patents:               PIP (auto accident) claims and             years. Three LMTs work at the clinic
if Medicare does not provide coverage          Workers Compensation claims will               along with a licensed hypnotherapist
for a service, they choose not to cover        usually cover massage therapy. For             who is also certified in EFT. Clark is an
it also. So, a person who might have           group health or private medical                active volunteer at Ocala Civic Theatre,
had massage therapy benefits for their         insurance, help yourself find the right        where he has stage-managed a half-
entire working life will lose that             answer. Research to discover whether           dozen musical productions in recent
medical service as a reimbursed                massage therapy is a covered expense in        years and has run the sound board for a
service once they convert to Medicare.         your own insurance policy. Ask your            dozen more shows. His clinic phone
     If national health care policies          medical service provider for a massage         number is 352-694-7255. Visit
change anytime soon, perhaps                   therapy prescription if it is needed. Ask

           Some of the Benefits of Therapeutic Massage
Massage works for chronic low-back pain               Fakouri, C., Jones, P. Relaxation       Treatment and Measurement. Med. J. Aust.
     People who get massage for sore           Rx: Slow Stroke Back Rub. J. of Geron.         161: 125-28; 1994.
muscles and pain say it gives them relief      Nurs. 13 (2): 32-35; Feb 1987.                        Ferrell-Torry, A.T. and Glick, O.J.
and helps them get back to regular activity.          Field, T., Morrow, C., Valdeon C.,      The Use of Therapeutic Massage as a
Recent research on the benefits of massage     Larson, S., Kuhm, C., Schanberg, S.            Nursing Intervention to Modify Anxiety
for some types of back pain has shown          Massage Reduced Anxiety in Child and           and the Perception of Cancer Pain. Cancer
that massage is effective in both relieving    Adolescent Psychiatric Patients. J. Am.        Nurs. 16 (2): 93-101; Apr 1993.
chronic low-back pain and for controlling      Acad. Child Adolesc. Psychiatry. 31 (1):              Palliat. Nurs. 1 (1): 21-30; Jan/Mar 1995.
some other back pain. Studies/resources:       125-31; Jan 1992.
       Cherkin, D.C., Eisenberg, D.,           Meek, S.S. Effects of Slow Stroke       Massage works to boost the immune system
Randomized Trial Comparing Traditional         Back Massage on Relaxation in Hospice               Your body’s immune system helps you
Chinese Medical Acupuncture, Thera-            Clients. Image. J. Nurs. Sch. 25 (1): 17-21;   fight off infections and illnesses, and it
peutic Massage, and Self-care Education        Spring 1993.                                   helps you recover from injuries. When you
for Chronic Low Back Pain. Arch Intern                Shulman, K.R., Jones, G.E. The Effec-   are under stress, the immune system may
Med. 161(8):1081-8; Apr 23, 2001.              tiveness of Massage Therapy Intervention on    not always work properly. Research among
       Preyde, M. Effectiveness of Massage     Reducing Anxiety in the Workplace. J.          different groups of people in very different
Therapy for Subacute Low-back Pain: A          Applied Behav. Sc. 32(2): 160-173; Jn 1996.    situations has shown that massage can
Randomized Controlled Trial. CMAJ.                                                            increase the immune system’s cytotoxic
162(13):1815-20; Jn 27, 2000.                  Massage works for cancer patients              capacity (the activity level of the body’s
                                                    Cancer and cancer treatments can          natural “killer cells”) and decrease the
Massage relieves stress and aids relaxation    cause physical pain and anxiety. Women         number of T-cells. The result is an immune
      After a massage, people say they “feel   who have mastectomies report negative          system that is working better. Studies/
good” overall. They also report a greater      feelings about being touched and must          resources:
sense of well being. When someone “feels       fight a common problem of lymphedema                   Field, T., Hernandez-Reif, M.,
good,” they usually hurt less, too. Massage    (a buildup of lymph in the arm after their     Ironson, G. Massage Therapy Effects on
has been shown to reduce blood pressure        surgery). Massage has been shown to            Breast Cancer. (unpublished); 1998.
and heart rate, and to increase blood and      reduce and relieve lymphedema, to relieve              Ironson, G., Field, T., Massage
lymph circulation. Massage also has been       pain and anxiety among hospitalized            Therapy is Associated with Enhancement
shown to increase endorphins, the body’s       cancer patients, and to help mastectomy        of the Immune System’s Cytotoxic
natural pain killers. Studies/resources:       patients recover from their reluctance to      Capacity. Intern. J. Neuroscience. 84:205-
         Cady, S.H., Jones, G.E. Massage       be touched. Studies/resources:                 217; 1996.
Therapy as a Workplace Intervention for                Badger, C. The Swollen Limb. Nurs.             Zeitlin, D., Immunological
Reduction of Stress. Perceptual and Motor      Times (England). 82 (31): 40-41; 1986.         Effects of Massage Therapy During
Skills. 84(1): 157-158; Feb 1997.                      Brennan, M.J.and Weitz, J. Lymphe-     Academic Stress. Psychosomatic Medicine.
         Culpepper-Richards, K., Effect of a   dema 30 Years After Radical Mastectomy.        62:83-87; Jan/Feb 2000.
Back Massage and Relaxation Intervention       Am. J. Phys. Med. Rehabil. 71: 12-14; 1992.
on Sleep in Critically Ill Patients. Am. J.            Bunce, I.H., Mirolo, B.R., Hennessy,   —American Massage Therapy Association
Crit. Care. 7(4): 288-299; Jul 1998.           J.M., et. al. Post-mastectomy Lymphedema       (

                                                                                                  November/December 2008

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