How does a massage therapist get covered by insurance?

To say that the process to become covered through insurance as a newly licensed massage therapist, is a nightmare is no exaggeration! In the beginning I thought billing clients with insurance or Medicare would be pretty straightforward. Unfortunately for me it is anything but!

To begin with, I have no training or education given to me through schooling that could help me know where to even start! From the 1,000 hour program there were zero hours dedicated to healthcare insurance billing and coding or becoming a network healthcare provider for individual organizations. In 2013, my instructors weren’t overly concerned with it because billing insurance wasn’t common and they wanted to prepare us for where most of us do start out…Massage Envy or similar employer. To start your own business after licensing is a financial risk that many of don’t take right away since we want to start paying off the student loan debt.

In 2010, the Affordable Care Act was passed and with that came uncertainties about massage therapists’ role in government-funded healthcare and the future of massage therapy for healthcare patients. After it was passed, massage therapy became officially known as an alternative medicine by the American government. This basically means they were not going to use government dollars on citizens having massage.

My first item of business was becoming a licensed business of Oregon and obtaining a facility permit from Oregon Board of Massage Therapists. Then I needed to obtain a TIN (government identification number) from the IRS with an official letter mailed by them to me. While waiting for those to process I obtained an NPI number. This is a unique 10 digit number issued to health care providers. Just like my Oregon massage license number, you can enter the number into a database online and find my first and last name, address, business, and contact information. Without an NPI a healthcare provider cannot become part of a network for government sponsored health insurance.

Next, was a surprising amount of forms to fill out. Forms that require additional forms to be filled out before that one has been. Forms so long they could have their own zip code! Now, if I am wrong please feel free to correct me but what I found as of November 2018, is that all government based healthcare rejects massage therapy as treatment they will cover. I’ve found that applications MUST be perfect. For example, I thought I did my very best completing one 60 page application only to wait 2 weeks for it to be mailed back to me for having missed checking off one box!

What I was reading online, compared to the information I was receiving from the general public, and the information I was finding on organizations, differed completely. Although I found Medicare was a dead-end for me, I also found that if a client has supplementary insurance with their Medicare or chosen health plan, that oftentimes that WILL cover at least some of the costs of a massage treatment. My application to Medicare was denied after waiting over 90 days for their decision but that just made me motivated to apply to Cigna instead. Cigna is a popular Medicare part B supplementary insurance provider and one that, after doing research, I found was quite willing to work with massage therapists in their network. In Gilliam County, Cigna is actually ran through a company called American Specialty Health. I currently have an application with them and have about 60 more days before receiving their decision. American Specialty Health covers those with Cigna, Kaiser Permanente, and Medical Fitness Network.

Wanting to include active military personnel and their families and veterans, I applied to be under network or working out of network with Tricare West. To my disappointment, I was denied as they do not accept massage therapy as a covered treatment for the military. To my chagrin, I noticed art and music therapy were covered by the government but not manual bodywork which can be therapeutic after physical and mental trauma!

Working through my list of companies and organizations I was then denied by Providence Health Plan (Medicaid in Oregon.) Having to print, hand-write, copy, email, fax, and repeat everything is time-consuming and exhausting. I now understand why so many licensed massage therapists are not network providers for health insurance companies. It’s a lot of work and a lot of waiting and disappointment (at least my personal experience so far) but for me it’s worth it to just keep plugging away at it and hoping for the best. I believe massage therapy should be available for everyone and can benefit so many. I want to make sure that people who legitimately need massage in their day-to-day can receive it through their insurance. Currently, I have applications pending with Oregon Health Authority, Pacific Source, Regence BlueCross BlueShield, American Health Specialty. A big thank you to the clients that are waiting for updates on this and I very much appreciate your patience and support.

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