The conversation typically goes something like this, the client says, “I would like to bill my insurance for an appointment.” I reply, “Were you in an auto accident or do you have a personal injury claim?” The usual response, “No, but…,” then I have to break the bad news, “I’m sorry, currently, the only way we can bill insurance in Kentucky is when your injury is part of a settlement and there has been a referral from a medical professional. The referral could be from your doctor, chiropractor….” This usually ends the conversation, occasionally the person will schedule regardless, but their visit will be paid, like the majority of appointments at Apex, with cash. The word currently is highlighted in the conversation because the inability to bill third party insurance by massage therapists might soon change. The change may come from language in the Affordable Care Act (ACA) that many disciplines, currently not able to bill third party insurance, are jumping on that could allow them to join this system. Not every practitioner wants to participate in third party billing, but most acknowledge this recognition would benefit their profession. I feel fortunate to attend the American MassageTherapy Association (AMTA) Board of Director’s meeting as the incoming president for our state chapter this past weekend in Evanston, IL, integrating massage therapy within the health care system was a key topic of the morning meeting. This article will provide a brief overview of the current outlook of massage therapists and consumers, section 2706 of the ACA that could allow billing, and the next steps massage therapists would need to take if they are interested in accepting insurance.
First insurance billing isn’t something all massage therapists want -the AMTA opposes forced participation- but a vast majority of therapists (96%) believe the services we offer should be considered part of the healthcare field, a sizeable majority (73%) already receive referrals from physicians, and over half of consumers (58%) would like insurance to cover massage therapy. Several states (seven) allow Medicaid and third party insurance coverage of massage therapy already, but section 2706 of the ACA has been interpreted by many in the massage field and other disciplines, such as midwifery, to include coverage nationally.
The language “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 certification or license” is the promising section. Although massage therapists are licensed in many states, most state licensure includes limited scope of practice regarding both diagnosis and treatment of medical conditions. Despite these limitations the AMTA has established committees to illustrate potential benefits for insurance providers and steps to overcome barriers for practitioners.
The committee is focusing on two areas of potential benefit, best treatment practices and provider savings, to approach providers with information that show massage therapy helps patients and saves money. First, by reviewing current and encouraging future research, the committee will provide recommendations for conditions that massage out-performs other options, such as low back pain or headaches. The second part, provider savings, is trickier, but by conducting program reviews of comprehensive treatment teams, including massage, the goal is to indicate that not only does massage improve patient satisfaction (really, who doesn’t likemassage), but could also significantly lower provider costs. The next task, possibly more difficult, will be the task of massage therapists educating themselves to work with healthcare providers.
Pualani Gillespie, BoD member-at-large and instrumental in the addition of insurance coverage in HI, addressed the process massage therapists should take if insurance billing becomes an option in their state. Her process included therapists thoroughly evaluating their diagnostic, treatment, organizational, and communications skills before even applying to become a provider. She also recommended therapists consider working as an employee for a medical organization rather than a spa or clinic due to administrative costs and difficulty in navigating the system.
As the incoming Kentucky AMTA Chapter president, my goal is to learn as much about this process as possible and establish appropriate education opportunities for therapists who want to pursue third party billing. At the board meeting I discussed this topic with the president of the WA Chapter, Marybeth Berney, where insurance billing has been allowed for quite some time and she acknowledged mixed benefits for massage therapists. She said massage does receive greater recognition, but shrinking reimbursements and administrative costs of insurance billing can be prohibitive.
If you would like to voice your opinion or support for ACA coverage of massage therapy please visit http://www.ihpc.org/ for more information. This has been a long, cold, winter, but not as cold just a little further north. If you look at the picture at the top of the article you will see frozen Lake Michigan along the Chicago skyline from the AMTA national headquarters. I feel very fortunate to be embarking in this new leadership role with our organization and I’ll keep you updated as I learn more about massage therapy legislation and research. In conjunction with what will hopefully be spring next month’s article will cover one potential side effect of increased physical activity, the dreaded “Charley horse.” If you have any questions or comments before then please email me, Jamagn01@gmail.com.