::UPDATE:: I’m happy to announce that if you have the APS employee/retiree plan from NM Health Connections, you’re covered, and I’m a provider! No doctor’s referral is necessary; you just pay your regular co-pay and I do the billing.
Short answer: Only in a few circumstances. In general, medical insurance just won’t pay for massage, although there are exceptions. It’s worth your while to find out! Here are the circumstances in which you might not have to pay out of pocket:
- Flexible Spending Accounts (FSA): FSAs and similar programs allow participants to set aside untaxed money from income to cover unreimbursed medical expenses. I can take payment from your FSA credit card and provide a receipt with CPT codes. I haven’t had one turned down yet.
- Car Insurance Medical Payments (MedPay, PIP): Medpay (PIP in no-fault states) is an optional coverage which pays for medical expenses if you’ve been in a car wreck, up to the agreed upon policy limits, no matter who is at fault. I strongly advising getting as much of this coverage as you can. It’s cheap!
Health insurance: Regardless of the hopes massage therapists and clients alike have about getting coverage under the Affordable Care Act (ACA), neither Obamacare nor the State of New Mexico mandates payments to Licensed Massage Therapists. As far as I know, no health insurance company operating in NM has LMTs as preferred providers, either. I would love to be able to accept your medical insurance, but even though I specialize in pain management and injury rehabilitation, health insurance just won’t pay me. One potential client told me that he needed myofascial release, but that his insurance would only pay for the treatment if I were a doctor, chiropractor, or physical therapist. A few PTs actually perform hands-on therapy, but for the most part they specialize in stretches and exercises. Some chiropractors also do soft tissue work, but they primarily adjust joints. I don’t know any doctors who do manual therapy, although I acknowledge that they might exist. It’s frustrating that health insurance companies won’t pay real experts like me, but they don’t.
The few (very expensive) policies that might actually pay LMTs usually have a separate deductible for “Alternative” health care practices like massage, acupuncture, and chiropractic. Unless you have extensive injuries or you have already met your deductible, you are probably better off paying me out of pocket at my time-of-service rates. Some insurance companies claim to cover massage, but they actually contract with LMTs to reduce their time-of-service rates in exchange for being listed in a directory. The client pays the reduced rate when they receive treatment. No bill is sent to the insurance company. Unfortunately, the only massage therapists willing to participate in such schemes are generally not competent to perform medically relevant massage treatments. Would you trust an inexperienced therapist to work on your frozen shoulder or plantar fasciitis? I wouldn’t. I want a well-trained, experienced therapist working on me, especially when I am hurt, not a new therapist who had a couple hundred extra hours of “medical massage” training tacked on to their 650 hour entry-level course. In my view, it takes years of practice to develop the sensitivity and specific palpation skills needed to confidently assess and treat serious medical needs. Since I have those skills, I am unwilling to reduce my time-of service rates just to be listed in some directory.
Medicare: No. Even Medicare Advantage plans do not cover treatments by Massage Therapists.
Medicaid: In NM, only those patients in the Mi Via program, which gives patients a budget to pay for their chronic medical needs. The good news is that I am a Mi Via provider. The bad news is that I need to charge a little more than my time-of-service rates because I have to wait for payment, which might blow your Mi Via budget.
Car Insurance: Good news! If you’ve been in a car wreck (motor vehicle accident, or MVA), you can likely get covered with little or any out-of-pocket expenses. If you have Medical Payments (MedPay), an optional coverage in NM, your company will pay your medical expenses immediately, regardless of whether you were at fault. I recommend getting as much MedPay as you can, and at least $5000; it’s cheap! I carry $10,000 of MedPay on my own car insurance policy, and I’d get more if I could. It costs me $12-13 every 6 months. I will not accept USAA MedPay because they routinely and arbitrarily refuse to pay my legitimate charges.
If the other driver was at fault, then his/her company will pay me for treatment as part of your settlement. This might take a few years after the accident, which is a long time to wait for payment. In order to protect myself, I require that you hire an attorney who will send me a document called a letter of protection, which essentially promises that I’ll be paid inasmuch as the recovery covers the costs of treatment. You won’t have to pay out of your own funds, and I am assured of some eventual payment. The days when you could negotiate a fair settlement from insurance companies on your own are long gone. They lie through your teeth, and you need an experienced advocate to protect your interests. I know some personal injury attorneys whom I think are humane and honest, and I’d be happy to refer you to one. However, any attorney who sends me a letter of protection is fine. You don’t have to hire someone based on my recommendation.
Personal Injury cases: You definitely need an attorney for this type of claim, in which liability is not as clear cut as with a car wreck. I can sometimes take this type of claim after consulting with your attorney.
Workers Compensation: I can bill Workers Compensation as long as you get pre-approval from the WC insurer. Generally your doctor’s office needs to arrange this for you. If you have a federal workers compensation claim (DOL/OWCP), please call me to discuss it. DOL is a strange beast, and difficult to wrestle payment from.