Many people don't realize that massage therapy services may very likely be covered by their existing insurance and/or healthcare provider.

Graph source: Massage Today Magazine, January 2003 Issue
www.massagetoday.com

INSURANCE BILLING
Prescription | Verification | Forms | Rates

Examples:

Group Health plans

Healthcare & insurance providers generally negotiate custom contracts with large organizations. Under some contracts, the employee would simply submit an expense voucher to their employer HR department for reimbursements.

Who would disseminate this information in your organization?

• Advertising by the insurance provider to the employees would not make financial sense for the insurance company.
• The HR personnel generally do not have enough staff simply to handle all day-to-day corporate activity.

Do some research to learn your full benefits in any group plan.

Personal Injury Protection

Most vehicle and real estate insurance contracts contain personal injury protection (PIP). PIP covers a broad range of medical expenses associated with any accident involving the property.

Most often, your insurance provider must by law pay for the massage services: You may need to obtain the following from your doctor:

• Prescription for massage
• Letter of Medical Necessity (LOMN) for massage

Determine which, if any, forms are needed.

Workers Compensation

Like personal injury protection, insurance providers must pay for any massage services related to Workers Compensation. The claims typically require:

• Prescription for massage from your doctor
• Letter of Medical Necessity (LOMN) for massage
• Progress reports from the practitioner

Determine which, if any, forms are needed for Workers Comp.

Always consult with your physician for any medical condition or advice. For medical massage therapy, your physician will provide a prescription, preferably indicating the proper diagnosis and procedural codes for massage.

For insurance billing, I require the following:

• Prescription / treatment plan from your doctor
• Letter of Medical Necessity (LOMN) from your doctor
• Verification of adequate insurance coverage

Massage therapists fall under the jurisdiction of the Board of Nursing in the Commonwealth of Virginia. We are not permitted by law to diagnose medical conditions or develop treatment plans for medical conditions. The diagnosis codes provided by your doctor specify the medical condition to be treated; while, the procedural codes designate the treatment approaches.

Consequently, I work under the specific direction of your doctor; I treat you as your doctor's patient, following the instructions provided within the prescription and LOMN.

We work together as a team, providing you with more integrated and comprehensive treatment approaches.

I strongly recommend that you contact your insurance and/or healthcare provider directly to determine the best way to be reimbursed for massage therapy.

The initial questions to ask would be:

• Does your plan cover massage therapy?
• May YOU submit invoices from the massage practitioner for reimbursement.
• Do the invoices need to be accompanied with a prescription?
• Must the prescription specify diagnosis and treatment codes?
• Must you provide a letter of medical necessity (LOMN), in addition to the prescription for massage services.

If your plan DOES cover massage, but the PRACTITIONER must submit the invoices for payment, then:

• Does your provider require the practitioner to submit any additional forms (e.g., CMS 1500 Claim Form)?
• Does your provider require the practitioner to submit Progress Reports with any claim forms, invoices, or prescriptions.

I will work with you insurance billing, then I can help you deal with insurance companies as follows:

• Verify your insurance coverage
• If necessary, send a letter to your physician regarding medical massage
• Obtain a prescription / treatment plan from your doctor
• Obtain a Letter of Medical Necessity from your doctor
• Submit claims for reimbursement by insurance
• Provide evaluation and progress reports to your insurance company, your doctor, you, and if necessary, your attorney

Start by contacting your healthcare insurance provider and your physician. I have provided several forms that you may use for assistance.

CLICK HERE FOR INSURANCE BILLING FORMS

Insurance Billing Rates for practitioner submission of claims differ from the Standard Rates for clients that pay by cash, check, or credit card. The Insurance Billing Rates conform to guidelines published for physical medicine reimbursement by the insurance industry.

These rates reflect charges that have been deemed usual, customary, and reasonable (UCR) by the American Medical Association, as published in the 2005 National Fee Analyzer, Ingenix, Inc.