Bevin Keely, LMP

Medical Necessity

To get your massage covered by your insurance, you will need a prescription from your doctor, even if your insurance plan says you don’t. This ensures that your massage is “Medically Necessary”, which keeps me out of trouble. It is outside of my scope of practice to diagnose your injury, and yet I must have a diagnosis code to bill with– thus, a prescription.

Additionally, you should be aware that insurance companies are pretty rigid in their definition of “Medical Necessity”:

“Benefits for inpatient and outpatient rehabilitation therapy services (such as massage therapy) are provided when such services are medically necessary to either restore and improve a bodily or cognitive function that was previously normal but was lost as a result of injury, illness or surgery.

Loss of function generally means a joint that doesn’t have full range of motion or full strength, or pain that prevents you from your activities of daily living.

Insurance companies are less interested in treating chronic pain syndromes; in my experience, they want to see results. If the treatment isn’t working within 6 -10 sessions, then it must be the wrong treatment. (See previous post.)