Are Massages Covered By Insurance
With many people turning to massage therapy as a medical treatment, it seems that health insurance should cover massages. However, not all policies do.
For example, Medicare does not cover massage therapy, so you will likely be responsible for 100% of the costs if you seek this treatment. Even if your health insurance provides coverage, there may still be limitations.
The definition of massage therapy may vary, depending on the insurer. That definition of massage, and the reason youre getting one, will likely determine whether insurance will cover it.
If massage treatment isnt covered in your policy, be sure to ask about alternative options. Its also a good idea to discuss them with your doctor.
Medical Claims Payment Policy Disclaimer
The intended audience of these medical claims payment policies is healthcare providers who treat Humana members. These policies are made available to provide information on certain Humana claims payment processes. These policies are guidelines only and do not constitute a benefit determination, medical advice, guarantee of payment, plan preauthorization, an Explanation of Benefits or a contract. These policies are not intended to address every claim situation. Whether a procedure is covered shall be determined based on the terms and provisions of a specific member plan or policy. Claims may be affected by other factors, such as state and federal laws and regulations, provider contract terms and our professional judgment. These policies are subject to change or termination by Humana. Humana has full and final discretionary authority for their interpretation and application.
âHumanaâ is the brand name for plans, products and services provided by one or more of the subsidiaries and affiliate companies of Humana Inc. . Plans, products, and services are solely and only provided by one or more Humana Entities specified on the plan, product, or service contract, not Humana Inc. Not all plans, products, and services are available in each state.
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Limitations and exclusions
Accepting Insurance Plans And Coverage As A Massage Therapist
Not all massage therapists accept insurance.
Some of this is by personal decision and others may not allow doing so.
The biggest reason a therapist may not choose to accept insurance is the headaches that come with the process.
Accepting insurance requires a substantial amount of paperwork.
Claim forms differ depending on the type of coverage that is paying or reimbursing for the therapy.
If the claims not filled out properly.
The medical billing codes arent entered correctly.
And other proper documentation did incompletely or incorrectly.
The therapist will not pay for their services.
Which then results in business losses.
This is especially hurtful to the individual therapist with a private practice.
For this reason, many massage therapists will not accept insurance.
Another reason LMTs may not accept insurance is because they not allowed to do so.
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Advice For Massage Therapists
For any LMT that wants to accept insurance.
They will need to check with their states governing board to see what requirements must meet in order to bill insurance companies other than Workers Compensation and auto insurance PIP.
Also, it would be a good idea to check with insurance providers in case the client hasnt done the proper checking to see if massage therapy services covered.
LMTs who wish to accept insurance may also want to hire a medical billing.
And coding professional to ensure that the proper codes entered in the proper places and claim forms filled out correctly.
Making sure detailed recordkeeping performed will ensure that the LMT will reimburse for their services.
Does Humana Cover Online Therapy
Yes, Humana provides coverage for online therapy and telehealth. They approved coverage for online visits with providers during the pandemic, so while unlikely, Humana may rescind this policy in the future. If you would like to see your therapist online rather than in-person, check with your Humana benefits to make sure that you understand your online coverage.
Generally, health insurance companies provide the same amount of coverage for all visit types, both in-person and online. This means that youll have the same copayments and coinsurance rates if you see your therapist through a virtual platform as if you saw them at their office.
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What Therapy Services Are Covered By Original Medicare
Original Medicare only pays for therapy services that are considered medically necessary.
If a therapy service is considered medically necessary, Medicare Part B typically pays 80 percent of the cost for the service and you pay 20 percent . In 2022, the Part B deductible is $233 per year.
If your therapy service is not medically necessary, your therapy provider must give you a written notice called an Advance Beneficiary Notice of Noncoverage before providing the service.
The ABN enables you to choose whether you want the therapy service. If you choose to get a service that is not medically necessary, you are responsible for 100 percent of the costs.
The Reason Why There Is So Much Ambiguity Accepting Insurance For Massage
There is one main reason that clients and therapists alike experience.
Such headaches when dealing with insurance, being covered, ability to accept insurance, being reimbursed, etc.
This reason is the current classification of massage therapy in the broader set of medical services.
Massage therapy falls under a treatment category known as Alternative or Complementary Medicine.
It is not defined under the Affordable Healthcare Act as essential benefits.
Thus insurance companies not required to cover it.
Also, insurance companies tend to not cover massage therapy as it is not under strict regulation and cant be completely verified as legitimate.
There is hope that this will change so clients who need massage therapy coverage.
And LMTs who wish to accept insurance wont have to go through a nightmare of paperwork and bureaucracy to receive or provide treatment.
Many practitioners and business owners are definitely on a quest to get Medicare to pay for massage therapy.
Time will tell whether patients can get massage therapy as part of their government insurance plans.
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What Types Of Therapy Does Humana Not Cover
If a therapy approach is not evidence-based that is, it lacks empirical research backing its efficacy Humana will not cover therapy costs.
This includes life coaching and career coaching, as these disciplines are less based on mental health diagnosis and more on goal-setting and achievement. Humana does not cover holistic approaches to treatment such as aromatherapy, massage therapy, or nutritional therapy. They also do not cover ketamine and psychedelic treatments, even if the purpose of this treatment is for a mental health condition. Humana does not cover energy work such as reiki healing.
How To Get Therapeutic Massages Covered By Insurance
For a massage to be covered by insurance, your best bet is to get a prescription or referral from your doctor. Even then, the insurance company doesnt have to agree to pay for it. Medicare, for example, doesnt cover massage therapy at all, so you would have to pay for 100% of the costs.
With other types of insurance, its well worth seeing if your insurance company will foot the bill. For example, it could be covered under an Affordable Care Act plan. Sometimes the easiest way to find out is simply to call your insurance provider and ask. Thats also a good time to ask them how much might be covered, to avoid any surprises.
The best way is to have a prescription from your physician, says Robin B. Anderson. Shes a licensed massage therapist and president of the Massage Therapy Foundation. It may be covered similarly to some other health procedures. If its deemed medically needed, then some coverage could be provided.
A 2018 study out of Rutgers University looked at how 7 insurance companies handled reimbursements for massage therapy. The analysis found that:
- 19% covered massage therapy as part of a rehabilitation plan
- 23% of companies limited therapy to 15-minute sessions
- 27% required a doctors prescription
- 27% said massage therapists werent covered providers. But other providers, such as physical therapists, could directly bill for massage services.
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Is Lymphedema Massage Covered By Medicare
Medicare coverage for lymphedema therapy is limited. Benefits do include manual lymphatic drainage, which is also known as lymphedema massage. To be covered, it must be performed by a qualified Medicare provider, such as a physical or an occupational therapist. Medicare doesnt cover compression garments but, in some cases, will cover a lymphedema pump if compression therapy doesnt work.
Curious About Our Ppo Plan Coverage
If the security of a broad range of benefits is your highest priority, all of our PPO plans offer all the benefits of Original Medicareand then some. Plans may include:
- Coverage for prescription drugs – most of Humanas PPO plans include coverage for prescription drugs
- Broad network of providers – with a PPO, you have the flexibility to visit providers outside of your network, but visiting an out-of-network provider will usually cost you more
- Dental benefits – unlike Original Medicare, many of our plans include coverage for routine dental care such as cleanings, exams, and X-rays
- Vision benefits – many of our plans also include coverage for eye exams, lenses and frames
- Hearing benefits – many plans include coverage for hearing aid devices, audiologist visits and ongoing fittings and exams
- PPO plans do not require referrals for any services
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Questions To Ask About Massage Therapy Coverage
If you learn that your insurer covers massage therapy, ask these questions so you will understand how your policy will cover it:
- What are the conditions to qualify for reimbursement?
- Is there is a deductible or any out-of-pocket cost to you?
- Is there is a maximum amount payable per policy term/year?
- Is there a maximum reimbursement per visit? For example, if the maximum per visit is $90, and you use a massage therapist who will charge $150, you will not be able to claim the full amount.
- Is there a time limit per body region?
- Are there specific massage therapists you must go to?
- Do all types of massage qualify for coverage?
What If Your Massage Isnt Covered
If your massage therapy isnt covered by your insurance, consider these options to help you find and receive affordable services:
- If you have a health savings account , you may be able to use it to cover massage costs if it qualifies as medically necessary. Learn more about HSAs and flexible spending accounts .
- Contact local massage schools to see whether they offer massages at a discount.
- Ask for discounts where you get your massage services.
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What If I Have Medicare Advantage
While original Medicare doesnt cover massage therapy, some Medicare Advantage plans may.
Medicare Advantage plans are private insurance plans. Theyre approved by Medicare, and they cover everything original Medicare does. However, these plans often extend coverage to other areas of treatment, including vision and dental care.
As of 2019, therapeutic massage is covered as a supplemental benefit under some Medicare Advantage plans. According to CMS, about 270 Medicare Advantage plans offer massage coverage, covering nearly 1.5 million enrollees.
For Medicare Advantage to cover massage therapy, youll need to:
Your Medicare Advantage plan may not cover 100 percent of the costs of your massage therapy. You may still owe a copayment or deductible.
Whats more, Medicare Advantage plans with these additional areas of coverage often cost more than more limited plans. However, those higher plan costs may be offset by the costs they cover for additional benefits.
Why Doesn’t Insurance Always Cover Massage Therapy
Unfortunately, massage therapy is still considered an alternative treatment, and insurance companies often won’t cover these types of treatment outright. Thankfully, there are a few methods by which you can attempt to achieve massage therapy insurance coverage for clients.
An easy way to increase your chances of massage therapy being covered by insurance is to ask your clients to obtain a referral from their primary care physician. In a recent survey conducted by the American Massage Therapy Association, 67% of respondents indicated that their primary physician recommended they receive massage therapy. A prescription or referral from a physician is important for reimbursement because massage therapists are not licensed to diagnose medical conditions. With a referral from a doctor, the massage therapist can include the ICD-10 diagnostic code and referring provider on their CMS-1500 form, and increase their chances of reimbursement.
One potential barrier to coverage is provider credentialing. A recent study involving health insurance policies nationwide showed that being credentialed as a massage therapist was not always enough to qualify for reimbursement certain companies required providers to receive pre-authorization prior to providing services.
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Does Original Medicare Help Pay For Outpatient Rehab And Physical Therapy2
Yes, Part B helps pay for medically necessary outpatient physical therapy.
Your costs:
- 20% of the Medicare-approved amount along with the Part B deductible
The amount you pay can depend on things like any other insurance you may have and the type of facility you use. Your doctor may also recommend services that Medicare doesnt cover or for you to get services more often than Medicare covers. Be sure to ask questions before your therapy starts so youre clear on how much you will pay.
Is Inpatient Rehab And Physical Therapy Covered By Original Medicare1
Yes, Original Medicare helps cover some services for inpatient rehab and physical therapy. Part A helps cover any medically necessary care you get and Part B helps cover doctors services.
To be eligible, your doctor must certify that you have a medical condition that needs intensive rehabilitation. You must also require continued medical supervision and coordinated care from your doctors and therapists.
Your 2021 costs for each benefit period are:
- Days 160: $1,484 deductible*
- Days 6190: $371 coinsurance each day
- Days 91 and beyond: $742 coinsurance per each lifetime reserve day after day 90 for each benefit period
- Each day after the lifetime reserve days: All costs
*You dont have to pay a deductible for care in an inpatient rehabilitation facility if you already paid a deductible for care in a prior hospitalization in the same benefit period.
What Original Medicare helps cover:
- Rehabilitation services, including physical therapy, occupational therapy and speech-language pathology
- A semi-private room
- Other hospital services and supplies
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What Are The Alternatives To Medicare For Massage Therapy Coverage
It is possible that massage therapy is covered by a few major insurance companies. However, the extent of costs covered would depend on the particular policy held by the patient and the premium paid as well as the state where the patient lives and receives the therapy.
For example, though Medicaid does not cover massage therapy at home, it may cover some costs of massage therapies when it is performed in a hospital depending on the patients specific conditions.
Also, different states have different requirements and laws for massage therapy coverage and reimbursement. Most insurance policies pay only a part of the costs of massage therapy services and these costs are reimbursed after the recipient has paid for the same out of his own pocket.
What To Do If Services Are Not Covered
If you are unable to guarantee massage therapy insurance coverage or reimbursement from your clientâs insurance company for services, you can employ a variety of other payment techniques that may be enticing to clients.
⨠Accept an HSA/FSA Card
Flex Spending Accounts and Health Savings Accounts are commonly used bank accounts that employees can set up through an employer to set aside pre-tax money to pay for qualified medical expenses.
By accepting FSA and HSA cards for massage therapy services, youâll enable your clients to use pre-tax dollars, that they have already set aside for healthcare expenses, to work with you. You will still get paid for your services, but you and your clients can avoid the stress of dealing with insurance companies or having to pay fully out-of-pocket.
⨠Include services in a package at a discounted rate
While this option still requires a client to pay out-of-pocket for your services, including massage therapy within a package at a discounted rate can help clients who need your services, but are struggling to pay. For example, if you charge $100 per session, you can offer a package of 5 sessions for $425, to make services more accessible to your clients lacking coverage.
This is also a great strategy for keeping your calendar full and ensuring consistent client appointments. With a package, clients are more likely to follow-up sessions, and use all of their credits. They wonât disappear after one or two appointments.
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Look Into Hsas And Fsas
There are a couple of medical-related acronyms that could save you money on massage therapy: Health Savings Accounts and Flexible Savings Accounts .
An HSA is a savings account you can use if you have a high-deductible insurance plan. It lets you put aside pre-tax money for medical expenses.
Some employers offer an HSA that can be used for wellness expenses, Anderson says. And that may include gym memberships and massage therapy.
An FSA, meanwhile, is an account offered as part of an employer-sponsored health insurance plan. It lets you set aside pre-tax money for certain medical expenses. That could include therapeutic massage. To qualify, you might need to get a letter of medical necessity.
According to the Internal Revenue Service, therapy that you receive as part of a medical treatment may qualify for HSA or FSA reimbursement.