Medical -Orthopedic Massage incorporates many different modalities and is only through health insurance as prescribed by a Physician, Naturopath, Physician Assistant, Registered Nurse, Chiropractor, Physical Therapist or other medical professional and differs from regular massage and bodywork. It is specific treatment based only and is specifically directed to resolve conditions diagnosed by a medical professional with a prescription or referral for medical massage therapy that contain diagnosis codes. Medical Massage is for rehabilitation of injuries and dysfunction that is measurable and not meant for a regular maintenance or relaxation massage. A variety of advanced massage techniques are used during the medical massage treatment (Neurokinetic Therapy, Neuromuscular, Myofascial Release, Trigger Point Therapy, Acupressure, Cupping Therapy, Gua Sha, Manual Lymphatic Drainage, Visceral Manipulation), but the focus of the treatment is only on the specific areas related to the diagnosis on your prescription provided. This enhances the body’s natural self-healing process and reduces the needed recovery time from injury. This is also the “health care law” that applies when using your health insurance benefits towards massage therapy.
In VS. Out of Network Health Insurance Provider
Please Note: Please not that as of July 1st 2017 the practitioner has requested removal as an in-network provider from all insurance companies effective July 31st 2017. Since the provider is “out of network” you will be required to pay the same day payment at time of service and you will be provided a super bill to submit to your insurance company. For WA State LNI no prepayment is necessary because your employer is paying for the treatment.
As of July 27th 2019 the provider has requested removal as an in-network provider of United HealthCare.
In Network Insurance Provider for Medical Massage:
- WA State Labor and Industry – LNI
Out Of Network Health Insurance Provider for Medical Massage:
- First Choice
- United Healthcare
- PIP – Personal Injury Protection
Note: Prescriptions-referrals are “required” for all in-network, out of network, PIP and Labor & Industry and prior approval is required even if your insurance says you do not need one. Some insurances like Regence, Premera and Group Health now require pre authorizations too. There are so many denied cases that we must make sure we will get paid and we want to make sure this would not cause you additional or increased out of pocket fees.
- Visit your Washington State primary care doctor, orthopedic doctor-surgeon, urgent care doctor, pain management doctor, chiropractor or physical therapist.
- Have your injuries examined and diagnosed.
- Get the doctor to write you a prescription with the ICD 10 diagnosis code, frequency (as to number of sessions per week/month and duration of time (as to how long such as 12 months or 4-6 weeks). The prescription must be for diagnosis codes that are reimbursable for massage therapy, meaning pain, strains, sprains and tears.
- If using insurance check to make sure your Insurance covers Massage Therapy and how many visits (If not PIP or L&I/Workman’s Compensation). Are you a Copay or Coinsurance. Have you met your deductible? After meeting your deductible what is your percent coverage i.e. 80%? This is your responsibility to know, we are not responsible for lack of reimbursements.
- Call our office and set up your appointments.
- Text, fax or e-mail your prescription to us prior with your online intake form. Suggested time frame to get us this is at least 4-5 days prior to your desired appointment.
- We must pre-approved and pre authorize all insurance if in network due to so many denied claims.
- We will submit your claim after each visit if we are in network, if it is a state LNI and if it is a PIP case. If we are not in network we will give you a super bill.
- If we are in network for you, It is your responsibility to make sure you do not double book alternative health care professionals on the same day. Many of us use the same billing codes and one of us will be denied, leaving you to pay additional out of pocket fee.
Many times using the term Therapeutic massage vs Clinical massage vs Orthopedic Massage vs Medical massage are interchanged. They mean the same thing just different words to describe them. For our website we have broken up the terms for ease of the different types of massages that are either less clinical vs more clinical. We do not have Orthopedic listed as a service. it is the same as medical massage but do Rx is needed and you will not be submitting to your insurance.
Here are some articles on scientific research done using Therapeutic massage therapy.
If you are needing a prescription for services that will either be billed to Health Insurance, Personal Injury Protection or Labor and Industry, here is a form to bring or email to your Doctor. They may require you to go in for an appointment for the Rx but some if you have been in recently will provide over the phone. The Rx can then be e-mailed or faxed back to our office.
Many Health Insurances will claim you can self refer but due to the fact that Massage Therapists can not diagnose, an Rx is needed. We must be sure it is medically necessary so that the insurance will not come back and deny payment which would cause you out of pocket expenses to us.
Benefits for massage therapy covered by health insurance is for rehabilitation massage only and not for maintenance massage. Maintenance massage is not covered by any health insurance as it is not medically necessary.