I do a fair amount of insurance work now. When navigating how to use massage benefits it can be strangely unclear in some areas. The big one is doctor’s referrals. Many insurances require a prescription. However, there are those plans that don’t. Instead they vaguely state that it must it medically necessary for them to use their benefit. Since massage therapists aren’t allowed to diagnose to whom does it fall to decide when something is medically necessary?
For the last several months I’ve been struggling with this gray area. Instead of waiting for a problem arise, I’ve decided to be proactive. I’m requiring people with insurance that says they don’t require a referral to get one, or at the very least a note from their doctor that says they should seek massage therapy.
While this may be inconvenient in the beginning I feel it’s very important. This will help to protect both myself and any of my insurance clients. If for some reason the insurance company wants to make sure there is a legitimate problem that little piece of paper will prove that the client wasn’t using their benefits incorrectly. If an insurance company deems that benefits were used when they should not have been they can require the provider (me) to pay them back for what was paid out. That leaves the client/patient responsible for covering the cost of those massages. I don’t want that to happen to me and I don’t want to put any of my clients in that position. My thought is a little pro-activity never hurt anyone. Thank you for understanding!
~Melissa