LowCountry Wellness Center

Healing by the Grace of God through touch...

Insurance Coverage

All Insurance Claims require a prescription from a Doctor with a diagnosis in order to be processed.  That includes all plans, even ones that say they are a self referring plan.  Billing Insurance requires that a condition be medically necessary which requires a diagnosis.  As a massage therapist I am not able to diagnose conditions.  Please print off the insurance verification form and call your insurance company if you have any questions. You will be required to pay for your therapy session at the time of  treatment, I will fill out all paperwork for the insurance company and fax or mail it to them.  I will also keep proper medical records concurrent with insurance regulations.  Because of these extra services, your treatment will have a $5 charge added to each session.  You can also ask me if you have any questions about this.  Thanks! Cyndi

 Your Health insurance may cover your massage therapy services if you are dealing with a specific injury or condition that can be resolved or improved by getting massage therapy - in the insurance companies words it must be "medically necessary" and the massage sessions must show improvement in your condition.

Medically necessary treatment is usually defined something like this:

Massage therapy may be considered medically necessary when performed to meet the functional needs of a patient who suffers from physical impairment due to disease, trauma, congenital anomalies, or prior therapeutic intervention. Maintenance programs are considered not medically necessary.

 Therefore, insurance does not cover massage for stress relief, soreness due to exercise or things like that. It also does not cover "maintenance massage".

Please check with your insurance company to get your definition of medically necessary as the definitions will vary with each company and to find out what your policy allows for as far as getting massage therapy. Please print and fill out this Insurance Verification form and call your insurance company to find out what your massage benefits are. Also bring the filled out form with you to your first appointment along with your insurance card and prescription.

You will need a prescription from your doctor stating the diagnosis of your condition along with their recommended treatment plan (the number of sessions per week and how long sessions should continue for.) Some insurance companies require that you pay a copay or a coinsurance payment. You can call your insurance company and ask them these questions or feel free to call me with any questions and I will try to help you as best I can.

If you have been in a Motor Vehicle accident, massage may be covered by your auto insurance Personal Injury Protection Coverage. As with any covered service, a prescription from your doctor is necessary. You will need to bring me your claim information including the claim number, billing address and claim representative.

If you have any questions about billing your insurance company for massage therapy services, please contact me.

 Understanding Massage and Insurance Benefits

Call your insurance company using the phone number that is usually on the back of your insurance ID card.  Ask them the following questions and write down your answers here.   Getting accurate information can reduce problems in the future. It is also important to get the person's name and record the time and date you talked to your insurance company. In WA State there is a law that says that once an insurance company has OK'd your service, they can not deny it later on. Having this information can be helpful in the event that they fail to pay for your massage services.  All plans to my knowledge require that you have a prescription from a doctor. Often insurance  companies will say that you don't need a referral and that you are able to self refer. The problem is that as a massage therapist, I am not able to diagnose your condition. This must be done by a doctor which requires a prescription. Some insurance companies don't understand this. Please call me if you have any questions.

Insurance usually only covers conditions in which the function of your body is impaired such as a pulled muscle, injury to the spine or muscles. It does not cover massage for sore muscles due to working out or from sitting at the computer unless it has gotten so bad that you can not turn your head or you have something like carpal tunnel syndrome.  Insurance only covers massage if you are injured just like if you were going to physical therapy. There is a treatment plan given by the doctor. There is a beginning to therapy and it ends when you are better.  If you are not seeing any improvement within a few weeks to a month you will be referred back to your doctor.

If you are in pain but there is no loss of function or the massage you are requesting is outside of the medical necessity of your specific insurance policy (depending on how your insurance defines medical necessity) you will need to pay cash for your sessions. Taking the initiative to take care of yourself and pay cash for your massage shows a commitment to your health and well being.  So taking the time to call your insurance company and find out just what your policy allows will save you time and headaches in the future. Let me know if you have any questions during this process.

Sometimes using the word "massage", causes the insurance representative to hear "luxury, pampering, relaxation" instead of rehabilitative.  So read what your policy covers before calling.  You may need to use the words Neuromuscular Therapy or Myofascial Release, which are both therapies that I am trained in.  Make sure the prescription is written for the above therapies when the doctor prescribes this for the insurance company.

FSA/HSA Instructions

In order to use your Flexible Spending Account (FSA) or Health Savings Account (HSA) or to file a claim with your insurance for massage therapy, there are usually a few steps to take.  Here are the the basics:

- Obtain a prescription for massage therapy.  Most medical practitioners are more than willing to comply  with this request.  I do not need the prescription to perform the massage, though if you'd like to give me a copy for your file, I will gladly accept it.  The prescription should include:

            1.  Length of treatment (i.e. - 2 times a week for 4-6 weeks)

            2.  Duration of treatment (i.e. - 45 minute therapeutic massage)

            3.  Reason for prescription (i.e. - chronic back and neck pain)

 - Schedule your massage appointment

- Obtain a "medical receipt."  Tell me this either when the appointment is made or upon arrival of the appointment, and I will mail this to your address of record or give it to you at your next appointment. 

What is an FSA?

A flexible spending account (FSA) is a tax-advantaged financial account that allows an employee to set aside a portion of his or her earnings to pay for qualified expenses, most commonly for medical expenses, and is offered through an employer’s cafeteria plan. Money deducted from an employee’s pay into an FSA is not subject to payroll taxes, resulting in a substantial payroll tax savings. The medical expense FSA (also medical FSA or health FSA), is similar to a health savings account (HSA), but medical FSA's are commonly offered with more traditional health plans. With most FSA, you must use up your funds each year.

 What is an HSA?

A Health Savings Account (HSA) is a tax-advantaged medical savings account available to people who are enrolled in a high deductible health plan. The funds contributed to the account are not subject to federal income tax at the time of deposit. HSA's are owned by the individual, and funds may be used to pay for qualified medical expenses at any time without federal tax liability. Unlike an FSA, funds roll over to the next year if not spent.

 Insurance Verification Form

Date and Time of Call:___________________ Name of Representative: ____________________

What are my massage therapy benefits?_________________________________________________

Do I need a prescription for massage therapy services?_____________________________________

What is the procedure code to be used?___________________________________________

What is the definition of medically necessary by your insurance company? It is often under the rehabilitation section of your policy. It usually says something about being only for purposes of rehabilitation for loss of function. 

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

 

 

 If they say no ask these questions to further clarify what type of plan and benefits you have:

Do they require that there be a diagnosis code given when billing.____________________

Is this a wellness plan?________________________________________________________

Does massage need to be medically necessary?_____________________________________

Do you need to have a prescription from your primary care physician or can it be from a chiropractor or

Naturopath or Acupuncturist? ________________________________________________________

How many sessions of massage are you allowed a year? ___________________________________

Are your massage benefits part of a combination of rehabilitation benefits that include other modalities

such as physical therapy? If so how many sessions total are allowed each year? _________________

Or what is the dollar amount that is allowed under your plan? ______________________________

What is your copay or co-insurance? _________________________________________________

What is your plan deductible? _________________ Has this been met for the year? _________

Remaining deductible amount if any? _______________________________________________