The Value of Massage

What is the value of massage?

I see this question as having two different meanings. The first one, referring to the monetary value of a massage, has a pretty easy answer. Depending on the city or town in which the massage is given, it’s typically valued at somewhere between $60 and $85. But the second meaning, the intrinsic value of massage, is much more complex. What is a massage worth?

Well, it depends on several factors. First of all, what is the goal of the massage? Is it for wellness? Prevention? Is it for physical pain? Stress relief? All of the above?

But just knowing the goal won’t answer the earlier question. How important is that goal? Is a client coming in for massages because she’s training for a marathon and wants to keep her legs and knees healthy? Is she coming in because she’s lived in pain for three years and has just now decided to do something about it? Which massage is worth more?

A new client is coming in for his first massage ever because he’s having the most stressful week of his entire life. A different client has been living under constant stress and pressure for years and has been coming to see you every month. Who will value their massage more?

But then, does it even matter?

In some sense, it doesn’t matter. A massage that someone values and appreciates is valued and appreciated regardless of its intent. But what happens when the intrinsic value of a massage comes into conflict with its monetary value? Let’s say that you suddenly have to start budgeting for expenses. Which items are the first to go?

I have some clients who are willing to pay for their frequent massages out-of-pocket because they know it’s what they need. I offer pretty good deals and discounts to help them out, to reward them for their commitment to getting healthy, but the fact still remains – this is money that they could spend elsewhere that they are spending on a massage.

I have other clients – well, potential clients – who cancel their appointment when it turns out that insurance won’t cover it. They know they could benefit from a massage, but it isn’t important enough to make the changes necessary to afford it. Sure, I know that some of these clients couldn’t afford to pay full price even with a modified budget. But not all of them. Clients from both of these groups – those who find the financial means to get a massage, and those who don’t – might have the same muscle problems, the same pain and tension. But they each assign a very different value to the massage.

As insurance coverage expands to cover more people and more services, I hope that the intrinsic value of massage will cease to be overshadowed by its monetary cost. No longer will financial considerations be the determining factor for whether someone receives appropriate treatment. Coming in for regular massages will be a thing that people do, not merely a thing that people dream about.

Likewise, as insurance coverage expands to cover more health care practitioners, the role of the massage therapist will change. What I hope most is that this will help to lend some legitimacy to our field. We are healers; we are medical professionals. I want people to know that massages can be uniquely beneficial for reasons far and wide. There is value in what we do.

In time, I hope that this means insurance companies will start to value our services as well. A solution to carpal tunnel pain that doesn’t involve expensive surgery? An answer to chronic back pain that doesn’t include a lifetime prescription to painkillers? I want to be put in the same category as other CAM providers, and not be overlooked or singled out as unworthy.

Sure, I have high hopes. But I think we’re on the right track.

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Evidence-Informed Massage Therapy

Last month, I wrote about the ten Essential Health Benefits (EHB) listed in the Affordable Care Act. These benefits are designed to restructure the way insurance works – new policies (including the benchmark plan and the plans in the exchanges) will all have to cover these ten criteria. Some of the benefits are broad, and I wrote about how a few of them could be interpreted to include massage services. Sounds like pretty good news!

But now I have something even better to share: In a project funded by AMTA-WA, massage therapists and researchers joined together to present a document outlining how massage therapy specifically relates to three of the EHB listed in the ACA. The document includes descriptions and citations of everything you need to convince someone on the efficacy of massage.

Check it out:
Evidenced-Informed Massage Therapy: The Research Supporting Massage Therapy is an Integral Component in the Affordable Care Act’s Essential Health Benefits [PDF]

Contents of the document:
EHB (5): Mental health and substance use disorder services, including behavioral health treatment
Anxiety & Depression
Sexual Abuse Recovery & Post-Traumatic Stress

EHB (7): Rehabilitative and habilitative services and devices
Scars
Athletic Injury and Post-exercise Recovery
Post-Operative Recovery

EHB (9): Preventive and wellness services and chronic disease management
Headache
Neck and Shoulder Pain
Low Back Pain
Fibromyalgia
Cancer
Temporomandibular Joint Disorder (TMJ)
Osteoarthritis
Emerging Evidence with High Clinical Value [other areas of wellness]

Download a copy of the PDF and share it with friends and colleagues!

Health Insurance: United

United Healthcare is a big insurer in my area, and recently, I think, it has gotten even bigger. A number of my clients found their companies switching to United at the beginning of this year after their original insurer changed its benefits package. I was a preferred provider through their old insurance, and I was contracted with United as well. My clients hoped that their new plan would continue to have a provision for massage.

Soon, though, many of my clients grew worried. An insurance rep had just given their office a presentation about their new health benefits. Acupuncture coverage, chiropractic coverage… but there was nothing about massage. My clients asked him directly if massage was a covered service. He said that it was not.

Or rather, that’s what one of my clients reported back to me. Another one told me that the insurance rep said it would depend on how the LMT billed for the service as to whether or not a massage would be covered. Huh?

To explain this better, let me show you some details of one of their policies.

At the top of the “Alternative Care” section is the list of excluded treatments. This clearly states that “massage therapy” is not a covered service:


Click image for expanded view

However, further down the page is a list of all covered CAM procedures. This section states that “manipulative services” are covered by insurance:

And what’s the difference between massage therapy and manipulative services? As far as it concerns LMTs, nothing. Massage therapy is CPT code 97124. Manipulative services is CPT code 97140. As I explained earlier, these codes can be used interchangeably.

And yet, if I was to bill United for a massage using the 97124 code, the massage would be denied. If I billed for the same treatment using the 97140 code (which, again, I am allowed to do), the massage would be reimbursed.

Why do insurance companies make this process so difficult? I really do want to give them the benefit of the doubt, but that’s almost too much of a stretch. When I looked at my client’s policy, the massage therapy exclusion was right there at the top of the Alternative Care section. If I hadn’t looked further (which I only did because I knew what to look for), I would have just assumed that any service provided by a massage therapist was not covered.

It’s not very hard to believe that insurance companies are doing this intentionally, and that they don’t actually want customers utilizing their benefits. That would mean more reimbursements for providers, which would take away from their profits.

How will Section 2706 prevent this from happening? It’s unclear to say exactly how. The terms listed out in the policy have to do with “services”, not providers. Insurance companies may still try to say that “massage” is not a medically necessary treatment and favor one CPT code over another.

This means that you, the massage therapist, need to know what to look for in an insurance policy. When you check on a client’s benefits, my advice is to look at multiple items. If you’re looking at the actual document, read all of the Alternative Care section. If you’re checking benefits over the phone, ask about both massage coverage and chiropractic coverage. If the language is contradictory, or if you’re unsure of what’s covered, submit the claim anyway. You might get reimbursed, you might get denied, but either way you’ll learn something.