Health Insurance: Providence (2)

After I found out about Providence Health’s backwards rules for massage coverage, I emailed them for more details. Why did they decide that chiropractors were more qualified to do my job than I was? Why did a doctor’s referral for a massage make no difference? Surprisingly enough, Providence wrote me back.

The beginning of the letter explained that not covering massage was solely a business decision (ie, not good for their bottom line). And although the insurance policies stated that chiropractors were allowed to give massages, these providers really shouldn’t be massaging for more than 15 minutes at a time (a single CPT code):

We have discovered over the past year that many chiropractors are abusing the massage therapy service that is within their scope of practice. We have developed a new policy which will correct the misconception that members can get massage therapy services from a chiropractor. I have attached the policy to this email.

I took a look at the attached policy. It stated:

Massage therapy may be used as an adjunct service to manipulation, especially when there is documented muscle tightness, swelling, and/or motion limitation due to spasticity or guarding. However, there is rarely a medical necessity for a one-hour, full-body massage. Typically, massage therapy (97124) is a targeted procedure to address a specific condition with the intent to provide relaxation of specific muscles or to reduce swelling related to the target condition. This is generally accomplished with one unit of message (up to 15 minutes).

I didn’t even know where to begin; the misinformation in this policy horrified me so much. Let’s break it down:

• Massage therapy may be used as an adjunct service to manipulation, especially when there is documented muscle tightness, swelling, and/or motion limitation due to spasticity or guarding. This is true. Massage is good at warming and loosening up the muscles in order for an adjustment to be effective. It should be noted, of course, that massage is not exclusively useful as an accessory to chiropractic. Which brings us to…
• However, there is rarely a medical necessity for a one-hour, full-body massage. Excuse me? By medical necessity, do you mean that there’s no proof that a one hour massage might… provide relief from pain during cancer treatment? Lower anxiety? Improve immune function? Decrease inflammation? Lower depression scores? (And not to mention all the pain relief that massage provides without the assistance of a spinal adjustment.) Also, the idea that just because a massage is long means that it’s unfocused (ie, a full body massage) is completely unfounded. More than half of my clients on any given week just want me to work on their neck, shoulders, and upper back. I’ve spent a whole hour just working on someone’s left leg.
  
  And besides – wasn’t the choice not to cover massage specifically a “business” decision? Why try to dress it up with medical misinformation? (answer: because “it’s not cost effective to provide effective healthcare” didn’t make it past the focus groups.)
• Typically, massage therapy is a targeted procedure to address a specific condition with the intent to provide relaxation of specific muscles or to reduce swelling related to the target condition. This is true, or at least it can be. As I said above, about 60% of my massages every week are focused on a specific problem area.
• This is generally accomplished with one unit of message (up to 15 minutes). Ha! If this were true, if any “medical need” a massage could provide could be accomplished in 15 minutes, our jobs as massage therapists would be very, very different from what they are now.

The original email then went on to blame the insurance customers (my clients) for being unable to figure out their benefits. If they wanted massage to be a covered service, they needed to talk to their HR.

But that wasn’t my point. Why was massage being separated out from other CAM therapies in the first place? What made massage less “acceptable” than chiropractic, acupuncture, or naturopathic medicine? Why did no one making these decisions feel the need to consult the research first?

It’s very hard to argue with someone (or something, like an entire corporation) that refuses to take facts into consideration.

I replied to this email, and our conversation continued for a while, but nothing was achieved. I was told that the public didn’t view massage as a medical service (not true!), so Providence wasn’t going to challenge perception. I was also told that the only reason that massage was a covered service in Washington State was because the chiropractors have a very strong lobbying group, and it had nothing to do with the medical value of massage (also not true!)

And so, again, this is what we’re up against. Misinformation at the highest level. But the new healthcare laws are on our side. As long as you know your rights as an LMT, and know that, as a licensed provider working working within your scope of practice, you’re entitled to fair compensation for your services, insurance companies will have to play by the rules.