*Please Note: I am no longer taking NEW CHP/Kaiser

self-referred clients*

Insurance: How it works

what are benefits?

You have a plan, and that is a good thing. The next thing to have is some idea of what your benefits are under your specific plan. Some plans cover massage, and some do not; whether your plan covers massage is something you need to find out BEFORE you schedule yourself online for the first time. I can help you check your benefits! Simply call, text or email me with your full name, your insurance ID #, Group # (if you have one, not everyone does), and your DOB. I will check your massage benefits only. If you want to know what your other benefits are, most insurance companies, who also want you to know what your benefits are, are happy to provide you with that information. The contact number for members is usually somewhere on the insurance card.

using your insurance company’s website

Let’s say you have a plan under Cigna and you search their website and find me on the list of providers. Well hey, that means you have massage benefits, right? Unfortunately it doesn’t. Anyone can go onto any insurance company’s website and look at the in-network providers list. Your specific plan determines what your benefits are, and the best way to find out more about your plan is to - yes - call your insurance company.

deductibles (booo)

A common stumbling block is the dreaded deductible. Knowing whether you have one, what it is and what that means for you is essential.

  • a deductible is the amount you need to pay first, before your insurance company will contribute one iota to any of your visits for anything. What often happens is, folks call to find out about their benefits, discover that massage is covered with a $20 copay, and forget that they have a $1500, $3000 or $6000 (or whatever) deductible, which they must first meet before they get to spend only $20 on a massage. The deal is, if you pay $340/month for an insurance plan, as an individual, you likely have a high deductible. If, on the other hand, you’re paying close to $500/month for an individual insurance plan, you have a lower deductible. That’s the trade-off insurance companies offer, and with a higher monthly premium often comes more benefits, although not necessarily massage. More on this later.

  • Insurance companies will not always offer you information, you have to ask. If you’re asking about massage benefits, it won’t always occur to the person helping you to tell you that yes you have massage benefits BUT you also have a deductible.

  • If you haven’t met your deductible, meaning, if it’s October and you haven’t shelled out $1500, $3000, or whatever your deductible is, it’s likely you won’t meet your deductible before your massage appointment, in which case you must pay the full cost of the massage. I can then bill your insurance company and whatever you pay me will be applied toward your deductible, meaning $80 (for an hour of massage) will be subtracted from your $1500, $3000, or whatever your deductible is.

  • If you are an individual who has purchased health insurance through the marketplace or independently through an insurance company’s website, you probably do not have massage benefits, or if you do, your deductible is really high. What you more often find are companies who offer massage benefits through workplace health plans, where the deductible (if there is one) is closer to $1500 and the company covers some of this and you have to cover the rest. Some companies are awesome and there is no deductible.

  • As you can see, there are a lot of ins and outs and the best thing to do is to call your insurance company and inform yourself, or call me and I can get some info for you, whatever you prefer. A caveat is, I’m not a professional insurance biller, so, you know, I do make mistakes although I do my best to be thorough.

prior authorization (here’s looking at you, Regence)

If you have Regence, and a lot of you do, you may not only have a deductible, but you might also have to get what’s called “pre-auth,” or “prior authorization.”

Regence uses a company called EviCore (which I refer to lovingly as evil core, but I digress), which they use to ensure that each massage is “medically necessary.” Never you mind that a person might have been run over by a truck in her 40s and is now, at 70, having body pains, the question is, does she need massage and is the onset of her complaint within the last two weeks? If not, too bad about that truck, no massage for her. True story.

Regence really wants you to get massage, but only if you meet their parameters and only for a certain number of times before they think you should try something else, like PT or chiro or Acupuncture for your complaint.

There is a procedure for this, so know the following:

  • onset of symptoms must be within two weeks of the request for massage

  • allow two business days for approval of your request, which your massage therapist must fill out on your behalf

  • your pain must impair or somehow impact your day-to-day living and massage must relieve this pain

  • be prepared to have anywhere from one half hour massage to four or even six one-hour massages approved, which must be scheduled within a one-month period. It really depends upon how recent your complaint is, how severe it is, and whether massage helps. After those are completed you must re-apply for authorization if you need to have more massages.

 

New seasons employees!

Did you know that for those of you with Regence, you can come get a massage for a $20 copay as long as your deductible is met? Call me if you’d like to find out more: 503.333.2425