LMT Interview – N. Weintraub

Name: Natalie Weintraub

Name of your practice: Natalie Weintraub, LMT

Location: I work out of my own office in downtown Portland, OR.

Number of LMTs working there: Just me.

How long have you been massaging? Three years.

How long have you taken insurance? Two and a half years.

What type(s) of massage do you do? Trigger point therapy and medical massage.

What’s your favorite part about taking insurance? My favorite part about taking insurance is that it allows more clients to see me frequently. Because I work a lot with pain management, my treatments are most effective when clients can come in every week to work out the most acute symptoms, and then monthly after that for maintenance. I try to offer good rates for those who have to pay out-of-pocket, but nothing beats a $20 copay. People are much more likely to take care of themselves when it doesn’t require a significant budget.

What’s your least favorite part about taking insurance? The most frustrating thing was being told by an insurance company once that a massage by an LMT was not covered because “there is rarely a medical need for a one-hour massage.” Try telling that to my clients!

What do you hope the new ACA laws will accomplish? I don’t want to have to tell my clients that they don’t have coverage for massages, even if they have a doctor’s referral, even if their insurance company had told them otherwise. Anyone who wants to get a massage should be able to, without the need for fancy policy riders. I don’t want cost to be the reason that someone isn’t going to get the healthcare they need.

What would you say to an LMT who is interested in taking insurance? Stay organized! It’s easy to lose track of who you billed, when you billed, and what you billed for when you don’t receive payment on the spot. Make a list. Make several lists. Whatever you need to do to keep track of things.

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Are you also an LMT who takes insurance? Answer the survey here!

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Massage Research

Very often I run into the argument that massage shouldn’t be covered by insurance because too many people view massage as a luxury. There’s no medical benefit to massage, they say; people just get massages because they feel good. Why would insurance pay for that?

If that’s the strongest argument they can come up with, then the problem isn’t with massage. Rather, the problem is with perception.

Massage therapy is already used regularly for PIP (personal injury protection) insurance claims. Motor vehicle accidents, workers compensation claims; every state (except, due a recent change, Florida) allows LMTs to participate in and bill insurance for these types of injuries. Whiplash? Go get a massage. Slipped and fell at work? Here, have a massage. And yet somehow, when it comes to health insurance footing the bill, massage therapy is suddenly belittled and overlooked, and insurers couldn’t possibly see a reason why it should be covered.

But I’ve got a whole host of reasons here.

Massage is useful for specific age groups, from infants (1, 2) and pediatrics (1, 2) to the elderly and those in hospice care. Massage has been found over and over to be beneficial for cancer patients, most notably for pain relief and decreased anxiety. Massage has been shown to help both those with eating disorders and those with fibromyalgia.

Getting a massage immediately after a strenuous workout has been found to reduce muscle fatigue and increase muscle tone. Massage helps with headaches, both tension headaches and migraines, along with TMJ and associated pain.

And perhaps the biggest, most obvious finding is that massage helps to reduce muscle pain.

And what about stress relief? Just “feeling good” has so many benefits on its own, including better job performance and increased mental well-being. No one can claim that a relaxation massages serves no medical purpose when there’s a whole field of psychology dedicated exclusively to the benefits of happiness.

We shouldn’t have to accept the belief that massage isn’t medically useful just because that’s the general consensus. We have so much evidence that suggests otherwise.

The next time someone asks you why massage should be a covered part of the healthcare, flip the tables around on them. Why shouldn’t it be covered? Getting massages is an integral part of self-care. And taking care of yourself is not a luxury. It’s a necessity.

Section 2706

Section 2706 is the Affordable Care Act’s note on non-discrimination. It’s been held up as the main section that guarantees equal insurance coverage for CAM providers. Let’s take a look at what it actually says!

SEC. 2706. NON-DISCRIMINATION IN HEALTH CARE.

(a) Providers.–A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage
against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.

[There is a (b) to section 2706, but it’s related to employee non-discrimination laws, which isn’t relevant to this conversation.]

I know that that law is a whole lot of jargon, but let me break it down:

  • [H]ealth insurance… shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification… This means that insurance can’t say that one group of licensed providers (eg, medical doctors) is covered under someone’s policy while another group of licensed providers (eg, massage therapists) are not.

That sentence, in and of itself, is the key to all of IHPC’s efforts. All providers must be covered. Simple as that.

  • This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. This means that licensed providers who want to work with specific insurance companies will still have to fill out the necessary paperwork and be accepted by the specific insurance company in order to work with its customers. They don’t have to allow all providers of every type to be contracted.

Note: This is already the case in states that allow health insurance to cover massages – for example, every time I’ve tried to contract with Kaiser/CHP, I’ve been told that they aren’t currently accepting new LMTs.

  • Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures. This says that insurers still have the right to vary reimbursement rates among providers.

I’ll be honest, I really don’t like that last section. How does one define or measure “quality” and “performance”? Will the reimbursement rates vary within professions (will some LMTs get reimbursed less?), or between different types of providers giving the same treatment? (iwill chiropractors and LMTs get paid at different rates if they both bill for a massage?) Will reimbursement rates be tied to research? Patients’ self-report? Healing time?

I’ve skimmed over sections of the ACA, and from what I can tell, these performance and quality measures have yet to actually be defined. Because there’s still a year before section 2706 goes into effect, there’s still time to for IHPC and other groups to discuss this and influence the decision.

Nevertheless, this is a solid ground for changing the rules and implementing for systematic coverage of CAM and massage.

There are a few other sections of the ACA that talk about integrative healthcare, and I’ll discuss them here in the upcoming weeks. Stay tuned!

AMTA Industry Fact Sheet

AMTA (American Massage Therapy Association) just released their Industry Fact Sheet for 2013. You should read it – it has all sorts of good information. Here are some of my favorite statistics:

How many massage therapists are there?

  • It is estimated that there are 280,000 to 320,000 massage therapists and massage school students in the United States.
  • According to the U.S. Department of Labor in 2012, employment for massage therapists is expected to increase 20 percent from 2010 to 2020, faster than average for all occupations.

Who gets massages?

  • Between July 2011 and July 2012, roughly 34.5 million adult Americans (16 percent) had a massage at least once, including 22% of women and 10% of men.

Why do they get massages?

  • Forty-three percent of adult Americans who had a massage between July 2011 and July 2012 received it for medical or health reasons.
  • Of the people who had at least one massage in the last five years, 43 percent reported they did so for health conditions such as pain management, injury rehabilitation, migraine control, or overall wellness.
  • Eighty-nine percent agree that massage can be effective in reducing pain.
  • Thirty-two percent of massage consumers had a massage for relaxation/stress reduction between July 2011 and July 2012.

How do people decide to get a massage?

  • In July 2012, more than fifty million American adults (16 percent) had discussed massage therapy with their doctors or health care providers in the previous year.
  • Of those 16 percent who discussed massage with their doctor or healthcare provider, 50 percent of their doctors or health care providers strongly recommended massage therapy/encouraged them to get a massage, compared to 45 percent in 2011. While physicians led the way in recommending massage (61 percent vs. 52 percent in 2011), chiropractors (43 percent vs. 50 percent in 2011) and physical therapists (38 percent vs. 49 percent in 2011) also recommended massage therapy when their patients discussed it with them. Twenty-five  percent of nurses recommended massage in 2012 versus 26 percent in 2011.

Massage and Healthcare

  • More than half of adult Americans (61 percent) would like to see their insurance cover massage therapy.
  • The vast majority of massage therapists (97 percent) believe massage therapy should be considered part of the health care field.

Integrative Care

I want to take a moment to explain some important but potentially confusing terms that I’ll be using on this blog. Specifically, I want to explain the difference between “integrative medicine” and “integrative healthcare”, at least in how I’ll be using them.

Integrative Medicine: This is another term for complementary and alternative medicine (CAM). CAM providers tap into a large pool of knowledge for their techniques, integrating Western medicine, Eastern traditions, and everything in between into their practice. Every LMT may say that they give massages, but no two massages are the same. Integrative medicine is also the union of various CAM techniques across disciplines, whether it’s naturopaths who give adjustments, massage therapists who perform fire cupping, or acupuncturists who utilize myofascial trigger points.

Integrative Healthcare: This term refers to the creation of an integrated system of care, in which all providers are able to utilize their expertise and deliver the most effective, comprehensive healthcare to the consumer. In an integrative healthcare system, a patient will have access to an acupuncturist just as readily as a primary care physician.

Integrative medicine has made huge leaps in the past few decades. Every day I come across new articles about how acupuncture can help with arthritis, massage is great for chronic back pain, and so on. If you mention “alternative care” in conversation, chances are good that people will know what you’re talking about.

With the implementation of the Affordable Care Act, which recommends the establishment of healthcare “teams” as well as a focus on preventative care, the national dialogue is shifting. Preventative medicine means cholesterol screening and mammograms, but it also means eating healthy and working out the kinks in your muscles before they become serious problems. Those who write the laws have realized that integrative healthcare is the only way to achieve the goal of providing comprehensive care to all Americans.

The conversation is changing. It’s time to listen.