Posts Tagged ‘health insurance’

Health Savings Account/Flexible Spending Account

Tuesday, January 14th, 2014

One of the trends I have noticed over the past couple of years is the rise in Health Savings Accounts (HSA’s). More companies seem to be choosing high-deductible insurance plans and contributing some money to attached HSA’s for their employees as health care costs rise and insurance premiums become unwieldy.

Massage therapy and bodywork is not specifically listed as an “eligible expense” on IRS Publication 502 describing tax deductible Medical and Dental expenses, but neither is it listed as “ineligible”. From what I can gather, a “letter of medical necessity” or a prescription from your physician would push my services into the “eligible” category.

Flexible Spending Accounts (FSA’s) work in the same way.

If you use your HSA/FSA without the safeguard of a prescription or a letter of medical necessity and are audited by the IRS, they could decide that your treatment was not properly documented as a qualified medical expense and that the money you spent is subject to income taxes and a 20% penalty.

The good news is that the threshold for determining medical necessity seems to be relatively low– your physician simply needs to explain it, and that should be sufficient. Here is a sample letter of medical necessity from my own HSA. Check the website from your HSA manager to find the form they prefer.

Medical Necessity

Monday, January 6th, 2014

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.)

 

Pre-Authorization

Monday, January 6th, 2014

Regence Blue Shield has recently begun to require pre-authorization for physical medicine services, including massage therapy. If your plan is administered by Regence, but independent of them (ex. King Care, UMP) this does not affect you.

I am still learning how this works, but it is supposed to go like this:

  • You come in for an initial assessment and treatment.
  • I submit for a pre-authorization online.
  • If you have not yet received any physical medicine treatments for the year, you get four sessions automatically, to be used within three months. This includes the initial treatment and assessment.
  • After four sessions, if you still feel that you need treatment, I then submit an updated treatment request showing changes you have made since the start of care, and outlining how we are going to quickly and efficiently get you healed within, say, another four sessions.
  • If you have already received some physical medicine treatments, including Physical Therapy, other Massage Therapy, and possibly Chiropractic care, I’m not even sure what we have to do. I haven’t jumped that hurdle yet, and as you may know, getting answers from insurance companies can be tricky.

Here is a chart showing their progress expectations:

I will update this post as I learn more about how this works in practice.

In the meantime, if you are a Regence client (not a King Care or UMP subscriber) and have had some physical medicine treatment already this calendar year, I will need you to contact me before you make your appointment so we can try to set the gears in motion.

Thanks.