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

Please read the explanations about the terms used and gain helpful advice in gathering information about your massage therapy benefits:

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.

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