Health insurance companies frequently shell out big bucks for medical treatments that may or may not correct a problem, yet are often complicated by side effects. Those same insurers withhold funds for effective, less invasive, less expensive holistic approaches like massage therapy. When approaching these common distributions from a logical perspective, the allocation of funds in healthcare appears to be askew. In the quest to cut costs and improve healthcare, many experts believe the benefits covered by insurers will soon shift towards complementary therapies, and massage therapists who are already signed up with CAQH will be on the receiving end of this change.
Despite the documented value massage therapy can have to the musculoskeletal, neurological, cardiovascular, digestive and endocrine systems, its acceptance into the medical profession has been slow. Most insurance companies provide for some type of reimbursement for chiropractic and physical therapy treatments, but less than 10 percent of massage therapy sessions are covered. When it comes to insurance reimbursement, massage therapy may qualify in the following types of situations:
- Insurance may cover massage therapy for a motor vehicle accident injury, although the laws vary by state.
- Insurance may cover massage therapy for Personal Injury Protection (PIP) claims and Workman’s Compensation (WC) claims.
- Insurance may cover massage therapy when prescribed by a physician, osteopath, chiropractor or physical therapist. In this type of situation, massage generally needs to be deemed “medically necessary.” Again, laws will vary by insurer and by state.
- Some employers offer special riders for massage therapy that involves a discount if receiving treatment from a network provider. In these cases, a therapist must be listed as an in-network provider.
Since laws and provisions vary by state and by insurance company, each client’s potential for massage therapy insurance coverage needs to be assessed individually.
As long as massage therapy is covered, a PIP or WC claim is typically a straight-forward process of insurance verification, billing and reimbursement. However, other types of coverage may require an initial, extensive application process. Applying to be a provider for an insurer is typically a grueling sequence of paperwork and extended lapses of communication. Thankfully, there is a unified system for submitting and verifying credentials that aids the application process: CAQH.
The Council for Affordable Quality Healthcare (CAQH) is a not-for-profit collaborative alliance of the nation’s leading health plans and networks. The mission of CAQH is twofold:
- To improve healthcare access and quality for patients.
- To reduce administrative requirements for physicians, other health care providers and their office staffs.
By developing one uniform application, CAQH’s participating organizations provide healthcare coverage for more than 300 million Americans:
- The CAQH Universal Provider Datasource® service is the industry standard for collecting provider data used in credentialing and member service resources.
- The CAQH application is a single, standard online form that is the centerpiece of this immense database.
- Providers in all 50 states and the District of Columbia can enter their information free of charge through an interview-style process.
- To help with any questions, CAQH offers complementary customer service on the telephone.
- Through its streamlined, electronic data collection process, the CAQH database reduces paperwork by mainstreaming the information needed by insurance companies and health plans for healthcare providers.
- Most health plans and insurance companies require massage therapists (or any type of healthcare provider) to be registered with CAQH to be considered eligible for approval and reimbursement.
Filling out the CAQH application takes time and patience, but only needs to be done once. The system will automatically check in with you several times a year to attest that all of your information is up-to-date; however, the initial effort will ultimately save therapists from the labor of mounds of paperwork.
Since few major medical insurance companies currently reimburse for massage therapy, being in the CAQH database may only help to credential a therapist for a small handful of insurers/plans. Yet, the future promises to bring an improvement in massage therapy insurance coverage. The health insurance industry is inching closer to accurately reflecting people’s needs in a cost-effective manner, making massage therapy the next profession to benefit from changes in healthcare. As such, the practices of massage therapists who are already registered in the CAQH database will be ready for business – poised for exponential growth.