Massage and Health Insurance: Get to Know Your Benefits

Over my last couple years as a massage therapist, and with the help from an experienced medical biller, I have learned a lot about the ways different insurance companies treat massage therapists.  I would say more than half of the patients I treat are covered under their insurance, but they all work a little bit different. This post goes into some of the struggles I deal with on a daily basis with insurance companies, and how the Affordable Care Act (ACA, ‘Obamacare’) has helped many of my patients receive treatment when they thought they weren’t covered.

The two most common, massage specific codes that massage therapists legally bill for are below:

97124 – Therapeutic Massage.  This code covers general massage techniques to promote increased circulation and relaxation of muscle tissue. Therapists who perform more relaxation, or Swedish-style massages would use this code.

97140 – Manual Therapy. This procedure code is used when performing mobilization/manipulation techniques, myofascial release, trigger point therapy, lymphatic drainage, traction, or any other manual therapy that promotes increased, pain-free range of motion and facilitates healing in order to return to functional activity.

When most people ask their insurance about whether or not they have massage therapy coverage, the customer service representative for the company will only look into the 97124 code, as that is the ‘massage specific’ code. Usually only higher tier plans will cover this code, so more often than not (unless you have a great plan) this code is not covered.

97140 – Manual Therapy typically always falls under the Physical Therapy/Rehabilitation category of an insurance plan, so if a person asks about massage coverage of their plan the insurance rep won’t usually mention this, as it is considered physical therapy.  One of the biggest changes to the massage therapy industry has happened when the Affordable Care Act went into effect. A Non-Discrimination Clause was imposed. Prior to the ACA being in place, insurance companies were able to dictate who could provide the treatment for 97140 (as well as other codes).  Most plans excluded massage therapists from being able to bill for it, even though it is legally within our scope of practice to provide it. Now they can no longer do that.  The clause states that as long as a provider is licensed by the state in their area of expertise, and are providing treatment legally within their scope of practice, the health insurance must reimburse for that service no matter what type of provider is performing the treatment (physical therapist, massage therapist, chiropractor, MD, osteopath, etc). This clause applies to non-grandfathered plans though (plans that have been set in place since before the ACA do not have to follow this clause).

Since what we perform, and specialize in at Performance Bodywork is more treatment/therapeutic oriented, 97140 is the type of treatment we typically are giving to our patients. For many of our patients we are getting them covered for treatment of conditions using their physical therapy benefits. Some of the private insurance companies we have had success billing for under PT benefits have been Aetna, Providence, Blue Cross Blue Shield (Regence/Anthem/Federal), Cigna and MODA.

There sometimes is a need for a referral/prescription for manual therapy from a Medical Doctor first in order to get the treatment covered, as the treatment needs to be deemed ‘medically necessary’ (similar to how LMT’s always need a prescription from a doctor for treatment of a car accident case), but that depends on the rules of a persons insurance plan, as not all of them are the same.  I am also speaking based on the plans I work with here in Oregon, so other states may have differences I am unaware of in the way LMT’s are reimbursed.

There have been occasions when after billing for the service I received a denial of payment because I am a massage therapist providing a physical therapy treatment.  Immediately we appeal and ask why it was denied, often noticing that many of these customer service reps don’t understand the new rules that have been imposed (even though it went into effect in 2014).  As long as the plan states they are covered for that code with no other specific regulations placed on it we have won those arguments and they end up realizing they are required to reimburse. It gets frustrating sometimes, and has turned into such a game, but definitely it is leading in the right direction for massage therapists in the health care industry.

So if you don’t have ‘massage’ coverage as part of your plan, you may still be able to get treatment for your injuries and pain from an LMT under your physical therapy benefits.




Insurance for Professional Massage Therapists

Exceptional Massage Liability Insurance

Smart practitioners realize that, while being named in a lawsuit is unlikely, it's not worth risking your career. In this sue-happy age (especially now, considering the current economic climate), even when you've done nothing wrong, it's expensive to defend yourself. Why chance it when excellent protection is so affordable?

Associated Bodywork & Massage Professionals (ABMP) offers liability coverage with the profession's highest aggregate coverages available: $2 million per incident, $6 million total per policy year. And these coverages protect you no matter where, or how many places, you work. These totals are per member, per year, not a shared member aggregate like other associations offer. You never have to fear if the insurance coverage will be there for you.

Also included are legal defense coverage (for covered losses) and no charge for obtaining an additional insured endorsement (AIE) if requested by your employer or landlord. All this is covered by your basic membership fee.

Unlike the claims-made coverage offered by some other providers, the insurance included with your ABMP membership is occurrence-form coverage, which protects you from late-filed claims. This added feature helps safeguard your business—and your peace of mind.

In addition, ABMP has procured coverage for hot stone massage and cupping—two modalities that are not always covered through other associations.

Bottom line: ABMP's liability insurance package is a comprehensive program specifically tailored for massage therapists and bodyworkers.

Sure, you can find bare-bones insurance coverage elsewhere. But are you sure you're protected? Not all insurance policies are the same. And consider ABMP's greatest strength: helping our members. If you do experience a claim, you can expect knowledgeable, empathetic assistance to help expedite rapid resolution of your claim. Fact is, just knowing your ABMP team is ready and able to support you lets you focus on what's most important—building a successful career.

Frequently Asked Questions
How quickly can I join ABMP and receive proof of insurance?
There are several options available to speed up processing. You can apply over the phone or on our website, or you can fax a completed application to us at 800-667-8260. We must also be able to verify training/licensing if no documents are supplied. If everything is in order, the insurance is effective the following day and your proof of insurance will be available by logging in to ABMP.com. If applying by mail, Three-Day Priority Mail Service ($15) ensures that the application will be processed and mailed within three business days.

When will my insurance go into effect?
Assuming all the required information is in order, your membership and insurance go into effect the day after receipt of your application, whether it is received by mail, fax, online, or over the phone, and it will be in effect for one full year from that date.

What exactly does my liability insurance cover?
The occurrence form liability policy that ABMP provides to qualified members covers the member's massage operations for professional liability (client alleges malpractice), general liability (client alleges injury/accident due to member's negligence), and product liability (client alleges reaction to product). The insurer will also defend you if someone sues you alleging your wrongdoing in covered losses; those legal expenses are provided in addition to the policy limits. That is, legal expenses aren't included in the policy limits like some other association's policies.


Why does a massage therapist need liability insurance?

Like any "hands-on" profession that deals with public health, massage therapy involves risk. Healthcare practitioners deal with clients in various states of physical well-being, and in such a high-contact modality like massage, the client's health and the physicality involved can make a recipe for a lawsuit.

Aside from the potential to aggravate a client's existing health condition, or in some other way cause injury, even the best massage therapist can't predict whether a client may trip over a rug and become injured, which might also result in a lawsuit.

Beyond that, massage creams may cause a client an allergic reaction. Such an event is outside the massage therapist's direct control and can also lead to a legal claim. Liability insurance for massage therapists provides peace of mind and crucial support for the massage therapist.

Without insurance, a legal claim can cost an LMT a good reputation, thousands of dollars, and may ultimately put a professional massage therapist out of business.

What is general liability insurance?
General liability insurance, also known as “trip and fall” insurance, will protect you in the event that a client trips and falls and is injured as a result. This type of coverage is critical to any business that allows clients onto a property, and it is one of three essential components of a good LMT insurance policy. Read more about general liability insurance.

What is professional liability insurance?
Professional liability insurance, also known as malpractice insurance, is the second key component to a comprehensive massage malpractice insurance policy. If someone claims an injury was incurred as a direct result of your lack of competence or skill as a professional massage therapist, having this type of insurance coverage will protect you. Malpractice insurance is highly relevant to any healthcare provider. Read more about professional liability insurance.

What is product liability insurance?
Product liability insurance provides protection in the event that a product used during a massage therapy session causes some kind of injury to a client. Since massage therapists often use products that come into direct contact with a client’s skin, this type of coverage is essential to LMTs. Learn more about product liability insurance.

What is rental premises liability insurance?
Rental premises liability insurance relates specifically to any place that you rent or lease for your practice. This type of coverage applies when damage occurs to the facility due to some negligence on your part to the rental space – from the drywall in. Contents of a rental location are not covered within this type of insurance.

What is the difference between occurrence form and claims made coverage?
The difference between occurrence form and claims made coverage is critical to understand when buying massage therapy insurance.

If you have an occurrence form policy and a claim is filed after your coverage ends, you are still covered for incidents that occurred during your coverage period. For example, if you have an occurrence form policy that ends on December 31 of a given year and you do not renew your policy, you will still be covered for any claim filed after December 31, as long as the incident in question happened on or before December 31 during the period of time that you were covered.

HOWEVER, if you have a claims made policy which ends on December 31 and you do not renew your policy for the following year, any claim filed after December 31 will not be covered, even if the incident in question happened on or before December 31 during the period of time that you were covered.

Does it make a difference if I work part time or full time?
Some massage liability insurance companies have very specific restrictions regarding what hours an individual may work while insured as a part-time or full-time employee.

If your part-time policy covers you for 6 hours of work per week, for example, and an incident happens during a week where you happened to work 7 or more hours during that week, the insurance company may reserve the right to deny your claim, since you worked hours beyond the limits of the policy. You would be better served by a policy that does not have a distinction between full and part-time work.

What does the advertised price often include?
The advertised price of a massage liability policy and what type of coverage that dollar amount includes varies greatly from program to program.

While some programs’ pricing reflects what you pay for general, professional, and product liability coverage combined, that is not always industry standard.

Some companies have a low advertised price, but will add additional fees, including application fees, association fees, processing fees, and certificate mailing fees. If you need an additional insured, this may or may not cost you extra. In some cases, you will be required to pay extra for the inclusion of certain modalities (e.g., hot stone).

When shopping, make sure to clarify what coverage is included or excluded in the quoted price, and how much the entire policy will cost with all of the features and benefits you want and need included.

What difference does it make if I am an employee versus an independent contractor?
Certain massage insurance programs will have different pricing and different rules for employees versus independent contractors.

As such, if you were to purchase an annual policy as an employee, but switch mid-year to an independent contractor position, you may unwittingly negate your insurance coverage.

Be sure to ask what may happen should you have a change in positions to make sure it won’t affect your coverage. You would be better served by a policy that does not have a distinction between employees and independent contractors.

Does it make a difference if waivers are required or not?
Several factors weigh into whether or not a liability insurance policy will provide coverage when a claim is filed, and one of these factors is whether or not the insurance company has asked or required you to provide your clients with “release of liability” waivers.

If the insurance company makes waivers a mandatory part of your insurance coverage, and you forget to have a client sign a waiver, or cannot provide evidence proving they, in fact, signed a waiver, the company may reserve the right to deny a claim. Knowledge is power.

Find out if the program you’re considering as your insurance provider requires a waiver, and make sure you understand fully how that may limit your coverage. You would be better served by a policy that does not require “release of liability” waivers from your clients.

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