Insurance Billing in Washington State

Guest post by Julie Onofrio, LMP

WA State massage therapists have had the luxury of billing health insurance companies for massage services since January 1999, when the US Supreme Court made the last decision in the long battle for insurance reform in WA State. This final fight was over the the Every Category of Provider Law that was mandated in 1993 by then insurance commissioner, Deborah Senn. Senn, along with the Clinician Workgroup on the Integration of CAM, filed a report in 2000 to help create a working relationship between health insurance companies and providers.

WA massage therapists are able to become contracted providers with all health insurance companies in the state after they apply to and pass a credentialing process. In exchange for being listed as a covered provider on the insurance’s website, therapists must agree to the fees set by the company, as well as agreeing to perform insurance massage only when it’s medically necessary.

An example of a Medical Necessity clause:

Massage therapy is considered medically necessary as adjunctive treatment to another therapeutic procedure on the same day, which is designed to restore muscle function, reduce edema, improve joint motion, or for relief of muscle spasm. Massage therapy is not considered medically necessary for prolonged periods and should be limited to the initial or acute phase of an injury or illness (i.e., an initial 2-week period).” [source]

Each plan varies in its definition of medical necessity, but in general a massage therapist can work on patients who have a current prescription, diagnosis, and treatment plan from the doctor. Insurance does not cover maintenance massage or palliative care. Large companies that are self-insured are exempt from this mandate.

The one major problem now is that many of the insurance companies have closed their provider lists – massage therapists cannot apply to become credentialed providers anymore. The companies say that they have too many massage therapists in each area of the state and can’t take any more.

In the early years after the Every Category law was enacted, many insurance companies paid their therapists very well – sometimes over $90 for an hour session. Through the years, though, the insurance companies have reduced their allowable fees and benefits. Doctors will refer patients for things like back and neck pain, hip pain, arm and shoulder pain, and many other conditions such as fibromyalgia and headaches, and these are covered by insurance. However, most insurance will not cover conditions such as anxiety and depression, even though there is compelling research showing that massage is one of the best options for these conditions. [source]

When Deborah Seen spoke at a convention I attended, one of the things she said was that, in the beginning, insurance companies did not understand that adding massage therapy to policies would decrease their overall expenses. For example, insurance companies thought that they would have to pay $10,000 for carpal tunnel surgery plus another $1,000 for massage services. They did not realize that, in many cases, massage therapy would eliminate the need for surgery entirely.

Today everything is done online. We bill insurance through programs such as Office Ally, which is free for providers. Insurance company websites and portals (such as One Health Port) make checking benefits, billing, and getting paid so much easier. The turnaround time for payment is generally only one to four weeks. We don’t usually have to send chart notes to companies, but we do need to keep SOAP charts on clients and have the prescriptions on file in case they are requested.

With the passing of the Affordable Care Act, the WA State insurance commissioner is creating a health exchange network that may or may not include massage. AMTA WA is watching this closely to make sure the Every Category law is preserved. In an effort to keep massage therapy covered, AMTA WA, along with Diana Thompson (former president of the Massage Therapy Foundation) and others, published a paper on the medical benefits and research findings of massage therapy. View the PDF here.

We don’t yet know how the ACA will affect the hard-won rights of Washington massage therapists, but we hope it will make things better both for us and for those therapists in rest of the country.

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