Major Medical Coverage
"Will My Insurance Cover Massage Therapy?"
The easiest response to this question is for you to call your customer service phone number located on your insurance card and request information on massage therapy coverage. ( Please see detailed explanation on verifying your benefits below)
There are several different types of insurance. Each insurance company and each policy have different rules and conditions for if when and how they will pay for massage.
The types of insurances that may pay for massage are
Major Medical PPO (i.e.. Blue Cross, Aetna, Humana, etc.)
Auto Mobile Insurance (PIP)
Workman’s Comp
The a few providers that usually do not pay for massage are
HMO’s
Medicare and
Medicaid
Verifying Your Benefits
Q: How do I find out if I
have coverage?
A: Phone the insurance company directly. And ask
Knowing the answers to these questions can prevent any misunderstanding of your
benefits and unexpected bills.
(Click here to print out our Major Medical coverage verification form)
Fax this verification form to (954) 476-3598
We will work with you determine if your insurance company will or will not cover your massage therapy treatment and give you two filing & submission options.
Two Options
You submit your own forms and paperwork
You verify your benefits on your own
You pay the regular price at the time of service
We issue you a receipt
You file the forms with your insurance company
Reimbursement from your insurance company is usually less that what was paid
This is for our regular massages
We submit your forms and paper work (a prescription from a Doctor may be required)
We confirm your verification of benefits
You pay the regular price at the time of service
You may need to provide us with a prescription from a Doctor or Chiropractor
We fill out the forms and submit them to the insurance company
We reimburse you when we are paid, typically for the full amount paid at the time of service.
A prescription is usually required
This is for our medical massage
Pre-approval
Once Holistic Massage & Wellness Clinics has received the verification of benefits form you filled out, we will contact your insurance company and ask for pre-approval along with your insurance company's coverage guidelines.
The Prescription
If your policy requires a prescription or if you want us to submit the billing, you will need to have the following information on your prescription.
Diagnosis codes
Frequency of Treatments
Total Number of Treatments
Name and UPIN# (Doctor's ID #)
State That Massage Therapy is Medically Necessary.
Once Holistic Massage & Wellness Clinics has received the verification of benefits form you filled out, we will contact your insurance company and ask for pre-approval along with your insurance company's coverage guidelines.
Financial Policy
The client pays Holistic Massage & Wellness Clinics the time of service, and the client then submits the therapist's bill to the insurance company for reimbursement. Or the client pays Holistic Massage & Wellness Clinics the time of service and we reimburse you when we receive payment from the insurance company. With either option payment is due at the time of service.
Q. What is medical massage?
A. Medical massage is clinical massage based on a physician's prescription, and performed with a specific goal for functional outcome. It is generally prescribed as a series of visits over a specified period of time - such as twice a week for six weeks, with work only to the diagnosed area. It is sometimes paid for by a third party, such as an insurance company.
EXPLANATION OF TERMS
Deductible: The initial amount that must be paid
out-of-pocket before insurance pays.
Co-Pay: An out-of-pocket fee to be paid to your service
provider at the time of each service.
Coinsurance: After a deductible has been met, there is a
coinsurance percentage. This number tells you what percent of the service your
insurance company will pay for (up to an allowable amount). Many insurance plans
will cover 100% after you've received a certain dollar amount in services (this
is called a stop loss).
Allowable amount: This is a predetermined amount that
your insurance is willing to pay for any given service.
Out-of-pocket expenses:
This is a general term for anything left unpaid by your insurance company,
including: deductibles, co-pay, and coinsurance.
Preferred Provider: This is what insurance calls their
contracted providers. In order to become a preferred provider, health care
practitioners must fill out an application and go through a rigorous screening
process.
In-Network: This is another term for a preferred
provider, meaning that the given provider is working in that insurance company's
network.
Out-of-Network: This is a term for practitioners who are
not preferred providers, or rather who have not been contracted your insurance
company. Many insurance companies allow for their members to receive treatment
from out-of-network providers under certain plans.
Explanation of Benefits (EOB): Whenever your provider
bills your insurance company for a service, your insurance company will send you
an explanation of benefits. This paper briefly explains what has been billed and
how much was or was not covered and why.
PIP and Workman’s Comp.
In addition to insurance, we also bill for Personal Injury Protection
(PIP) claims and Workman’s Comp claims. The process
for these are a little bit different, but, again, we'll do all of the
researching and billing for you. With a PIP and Workman’s comp claim, you'll
have an adjustor assigned to your case. The adjustor is the person in charge of
managing your claim, and whom we'll work with directly in order to make sure you
get the paid treatment that you need. Most PIP and Workman’s comp claims will
remain open until you've reached the dollar limit for treatment, you are no
longer affected by your injuries, or your claim becomes dated.