Trying to get insurance companies to cover massage therapy has been an ongoing and often difficult challenge, especially for those who have a private practice. Traditionally, the easiest route has been to file through Workmen’s Compensation as well as certain disability programs, or automobile accident claims. Less often, there have been some private companies, or insurance programs that also offer coverage for massage therapy, but many want the therapist to sign up for programs that pay at a lower session rate as a perk for employees.
The good news is that may be changing. Insurance coverage for massage therapy may soon be available nationwide. The bad news is that it may mean more paperwork, especially for small businesses. Ultimately it means that perhaps more people will seek massage therapy as an alternative therapy – and so the profession as a whole will grow.
Known by many names as it passed thorough and was revised and amended by Congress, it is generally referred to as the Patient Protection and Affordable Care Act (ACA) – H.R. 3590. It was introduced in September 2009, passed in December 2009, and signed into law March 2010 by President Obama. Some have referred to it as healthcare reform, but it is more about changes in how Americans are covered by health insurance and a basic requirement for all citizens to have it, with various aspects being implemented over a number of years.
How it May Affect Massage Therapists
Section 2706 – Non-Discrimination in Health Care (of the ACA) is the component massage therapists should be concerned about. It will be implemented in 2014. In part, it reads:
“(a) Providers – A group health plan and a health insurance issuer offering group of individual health care coverage shall not discriminate with regard to participation under the plan or coverage against any health care provider who is acting within the scope of that providers’ license or certification under applicable State law. This section shall not require that a group health plan or health insurer 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.”
By not excluding any particular profession, the law is stating that any licensed or certified healthcare professional (such as massage therapy) will be covered by insurance as required by this act. Perhaps a bit of a caveat here is that the insurance provider can determine the rate at which they pay. If they react similar to Workmen’s Compensation rules, it means they may pay less than the going rate, which can vary greatly from state to state, and is never more than the therapist’s usual fee even though there is a lot more paperwork and time involved for the provider.
What is less clear is what happens regarding coverage in those states where massage therapists are not required to be licensed by local or state law (currently there are seven states without regulation of massage therapy), but may be nationally credentialed by a professional organization such as the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB). Also of concern is how, or even if, the states which choose to opt out and provide their own mandates regarding healthcare insurance will address this.
One of the organizations addressing the confusion and working to clarify it is The Integrated Healthcare Policy Consortium, whose members consist of various alternative healthcare organizations such as the American Massage Therapy Association, Bastyr University, American Association of Acupuncture and Oriental Medicine, National Association of Midwives, and many others representing various natural therapies. The executive director of the Consortium is a well known advocate of massage therapy, Janet Kahn, PhD, LMT.
Also of importance to massage therapists is that insurance companies must offer a set of essential health benefits in the following 10 categories:
- ambulatory care
- emergency care
- maternity and newborn care
- mental health and substance abuse
- prescription drugs
- rehabilitative and habilitative care
- laboratory services
- preventative and wellness services
- pediatric services
Massage therapy could be considered under rehabilitative and habilitative care as well as preventative and wellness services. This may vary from state to state, depending on how the insurance plans are implemented. For example, California is including acupuncture treatment but only for certain things like treatment of nausea or as part of a pain management plan. They will be specifically excluding massage therapy, infertility treatment and hair growth treatment. Other states will have their own restrictions, exclusions and inclusions. This makes it imperative that each healthcare provider be aware of his or her local and state laws regarding implementation of the ACA.
The confusion will undoubtedly come in with regard to wording. “Essential” benefits differ from “mandated” benefits. What is considered rehabilitative or preventive will need to be defined for clarity and hopefully consistency.
What does this mean for massage therapists and other bodyworkers or providers of alternative healthcare? For one, it probably means a maze of confusing terms and policies. It will take time, research and experience to work out all the kinks. In the long term though, it makes for some exciting possibilities – like a substantial increase in individuals seeking massage therapy as a way of maintaining good health and, by extension, an increase in your income potential.