I accept Regence Blue Shield and Premera Blue Cross. Both Companies require that you have a pain condition AND a loss of function.
That means that you MUST also have some degree of not being
able to sit, stand, walk, stair climb, lift, work, personal care, drive, or sleep because of or in addition to your pain.
Each has different requirements and benefits that you will need to know and be responsible for. Please read more at these pages: Regence Blue Shield and Premera Blue Cross
ALL Plans require that massage therapy be medically necessary and each plan has their own specific definition of what that means. Check your policy. Here are some sample definitions of medical necessity.
All insurance claims must have a prescription from your doctor with a diagnosis in order to be processed, no matter what the insurance company says. A prescription is different from a referral. Some plans will say that you do not need a referral, but you still will need a prescription. A prescription will provide a diagnosis code and a treatment plan stating the number of sessions the doctor is prescribing and the duration. (Example: 1x a week for 6 weeks)
You will be allowed 6 sessions to be completed without prior-authorization. After that, your insurance requires that I obtain a prior-authorization from a company they have hired called eviCore, before completing more sessions.
Insurance will only cover
massage if there is an injury or condition that makes it medically
necessary to get a massage. Medically necessary massage therapy is done once or twice a week depending on the prescription and condition.
It does not cover massage just for stress, anxiety or depression.
It does not cover maintenance or preventative massage. Each insurance company has their own definition of maintenance massage. I define it as massage therapy done once a month, every three weeks or every other week. Massage must be done (time allowing) once a week for massage to give the best benefits. I have to show that there is improvement in your condition.
It does not cover soreness due to exercise.
Some of the conditions that massage can help and that your health insurance will cover are:
Use this handy insurance verification form (PDF) if you call your insurance to investigate your massage therapy benefits.
Fibromyalgia is a chronic and debilitating condition that can be helped with massage therapy. It is characterized by myofacial (muscle and the covering of the muscles which is called fascia) pain. It is a complex syndrome characterized by many symptoms such as musculo-skeletal pain, fatigue, sleep disorders, pain, tenderpoints, adrenal stress to name a few.
Diagnosis fibromyalgia is usually a matter of ruling out other conditions and diseases such as Lyme disease, multiple sclerosis, rheumatoid arthritis and lupus. You also must have chronic pain for more that 3 months, have 11 of 18 tenderpoints in all 4 quadrants of your body and have persistent fatigue and sleep does not relieve the fatigue.
There are also many complications as the condition usually has some overlapping symptoms such as chronic fatigue syndrome, irritable bowel syndrome, myofascial pain syndromes, adrenal and thyroid issues. Depression and anxiety are also usually present and it is unclear which came first.
One of the first things to be considered is the functioning of the hypothalmic-pituitary-adrenal axis which seems to be one of the first things that go wrong in the body. It is the main stress responder. For more on this see: Fibromyalgia and Chronic Myofascial Pain by Devin Starlanyl
Causes of Fibromyalgia Fibromyalgia is often associated with some serious life trauma or unremitting grief over a life situation. It can also be from a series of trauma (I just lost my busineess, my house, my life partner and my mom just died.) Fibromyalgia can have multiple causes.
Treatment of fibromyalgia The first step in treatment is to educate clients about this condition. It is not a life threatening disease and it is not progressive. Fibromyalgia clients usually have such a diverse and unique set of symptoms that it is sometimes hard to believe that it is all really fibromyalgia. I often think that doctors just diagnose people with fibromyalgia when they don't know what else is wrong with someone.
Some people respond better with the use of light massage while others respond better with deep tissue and triggerpoint massage therapy. Finding what works best for each person is a matter of trying different approaches to see what works best which often can exacerbate symptoms until the right approach is found.
People with fibroymalgia also benefit greatly from changing their diet to a sugar free, gluten free, dairy free diet which helps reduce the stress on their bodies. One of the first questions I ask people with fibromyalgia is what happened to you in the past two years before being diagnosed with fibromyalgia? I also ask "what do you think you need to do to heal this condition"? Stress can be anything from serious trauma from an accident or injury to major life and work changes such as changing or losing a job and divorce or death in the family. One of my massage school teachers described it as all of the stress just bouncing around in your body unable to get out. We hold so much of our emotions in check that is causes even more stress.
It is also recommended that you consult with a Naturopathic Doctor to have your adrenal glands tested for adrenal fatigue as well as getting your thyroid checked. (ND's will look at thyroid numbers differently than MD's to find a pattern of them gradually getting weaker.)
What massage does for fibromyalgia is to help reset the stress response system by providing feedback to the body about it's state of tension.
The Digital Natuopath- Fibromyalgia and Chronic Fatigue
Fibromyalgia Articles on Healthy.net
Treating Fibromyalgia Massage Therapy as a Beneficial Tool By Ross Turchaninov and Boris Prilutsky