Health Insurance
Do you have questions about your health insurance’s massage coverage? What about your Personal Injury Protection attached to your auto insurance? We outline the basics here…
Health Insurance: Did you know that Washington State actually has legislation requiring insurance companies to cover your medically necessary massage sessions as administered by your Licensed Massage Practitioner?
Personal Injury Protection (PIP): When you are in an auto accident, your auto insurance may include coverage that pays for your medical care, including medically necessary Massage Therapy.
Health Insurance Coverage
We are fortunate to live in Washington, a state who not only acknowledges the efficacy of complimentary medicine, but also honors the skill and knowledge of the highly trained professionals who practice here. Many states only cover massage when performed by an M.D. or Physical Therapist. Learn more about potential changes to these consumer rights here…
At Seattle Bodywork Cooperative, many of our practitioners are preferred providers for a variety of insurance carriers, including:
- Premera Blue Cross
- Lifewise of Washington
- Uniform Medical Plan
- Aetna
- Cigna
- First Choice Networks
Each company serves many different plans that provide different levels of coverage with many different allowances and limits. It helps if you are able to contact your insurance company for the details of your plan such as deductibles, copay/coinsurance amounts, maximum out of pocket levels, and massage-per-year limits.While each practitioner has their own billing systems and cycles, there is a general procedure for getting your massage treatments covered by your plan:
REFERALS: Many plans require “medical necessity” to cover your massage treatments. This can be established by a doctor’s prescription or referral—including a diagnoses code and treatment plan. This is submitted with the first claim and kept on file at our office and your insurance file.
COPAYS/COINSURANCE: Most plans require some out of pocket at the time of service over and above any applicable deductibles. In some plans this is a percentage of the maximum allowable charge, while others a flat rate. These rates are plan specific, you can verify your rate by referring to your plan documents or insurance card.
PAYMENT: As long as your plan requirements have been met and your copays paid, your therapist will submit claims to your insurance plan and payment will be sent directly to the practitioner. If your claim is denied and reasonable efforts are made by your practitioner to correct the claim and collect payment, you the client are ultimately responsible for final payment. Please stay in contact with your practitioner regarding your claims to make sure you do not accrue charges that you could not repay.
Personal Injury Protection (PIP)
When you are in an auto accident, different insurance coverage may apply. Regardless of who’s at fault, if you subscribe to PIP coverage as part of your insurance plan, then your medical treatments, including massage therapy, should be covered. There is no preferred provider system for PIP. Any LMP in the state can bill your insurance for these treatments.
A prescription or referral for massage therapy from an MD, ND, or DC is required prior to your first treatment. Most practitioners will require you to sign a “release of medical records” statement that allows them to send copies of their chart notes to attorneys and insurance adjusters. Claims for PIP often require that practitioners submit chart notes with each claim, therefore you may experience more detailed testing and interview time at each massage session to gauge progress in healing.
As with health insurance, your LMP will bill your insurance company for direct payment. You usually owe nothing out of pocket.
In some severe PIP cases, your own coverage may be maxed out. If you are not at fault and the other driver was insured (the 3rd party), your insurance company will pursue the erd party for damages you incurred. To continue your treatments, this scenario often goes one of three ways:
- The 3rd party pays until their client’s limits are met. (Yay!! This is the best scenario.)
- You pay out of pocket or bill your health insurance and hire an attorney to sue the 3rd party for a settlement that will reimburse you.
- You arrange with your practitioner to continue services “on credit”, to be paid when a settlement is reached. **Not every massage therapist will be able to do this. Those who can may require you to sign a “guarantee of payment” statement and file a lien against your settlement. These cases can drag out a very long time—many years at times—so discuss all available options with your practitioner before taking this route.
