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.