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Massage Therapy and Health Insurance

The US is way behind in getting massage therapy covered by health insurance especially because there are two states, Washington and Florida that have had massage therapy covered by their insurance and in WA it has been for over 20 years.

There is much controversy over why we currently do not have health insurance coverage of massage therapy. Some of the issues are:

  • Lack of research that supports the use of massage therapy
  • Lack of standards of education among massage schools
  • Lack of political support in each state legislature. (Right now massage therapy is regulated by each state and the definitions and scope of practice vary greatly).
  • Lack of national political support.
  • Lack of Political Action Committees in each state and nationally to work on this issue.
  • Lack of professional associations involvement in making this happen.
  • No one is standing up for the massage profession.

History of Massage therapy and health insurance in WA State.

Massage therapy became covered by health insurance back in around 1999 after a law was created in 1993 by the current insurance commissioner – Deborah Senn. The law is called the ‘Every Category Law’ and is still here today. The law states:

WAC 284-170-270

Every category of health care providers.

(1) Issuers must not exclude any category of providers licensed by the state of Washington who provide health care services or care within the scope of their practice for services covered as essential health benefits, as defined in WAC 284-43-5640 and 284-43-5642 and RCW 48.43.715, for individual and small group plans; and as covered by the basic health plan, as defined in RCW 48.43.005(4), for plans other than individual and small group.For individual and small group plans, the issuer must not exclude a category of provider who is licensed to provide services for a covered condition, and is acting within the scope of practice, unless such services would not meet the issuer’s standards pursuant to RCW 48.43.045
(1)(a). For example, if the issuer covers outpatient treatment of lower back pain as part of the essential health benefits, any category of provider that provides cost-effective and clinically efficacious outpatient treatment for lower back pain within its scope of practice and otherwise abides by standards pursuant to RCW 48.43.045 (1)(a) must not be excluded from the network.

(2) RCW 48.43.045 (1)(a) permits issuers to require providers to abide by certain standards. These standards may not be used in a manner designed to exclude categories of providers unreasonably. For example, issuers must not decide that a particular category of provider can never render any cost-effective or clinically efficacious services and thereby exclude that category of provider completely from health plans on that basis.

(3) Health plans are not prohibited by this section from placing reasonable limits on individual services rendered by specific categories of providers based on relevant information or evidence of the type usually considered and relied upon in making determinations of cost-effectiveness or clinical efficacy. However, health plans must not contain unreasonable limits, and must not include limits on the type of provider permitted to render the covered service unless such limits comply with RCW 48.43.045 (1)(a).

There is more to the law too: See https://apps.leg.wa.gov/wac/default.aspx?cite=284-170-270

In 1993, when the law was first created the insurance carriers fought it and the battle lasted about 4 years but in the end there was a Supreme Court Ruling that made it so. A workgroup was created to implement the law. You can read the full timeline of events and see the report (Issues in Complementary Medicine ) from the workgroup on my other website. The final ruling “January 1999    US Supreme Court denies Plaintiffs petition for Writ of Certiorari, leaving the decision of the Ninth Circuit Court of Appeals to stand” meaning the law went was preserved and went into effect. 8/28/99.

The Call to Action

Getting your insurance carrier to cover massage therapy will take some doing. The main thing to remember that it is first about getting massage therapy covered for health conditions such as those talked about on this website where massage therapy has been shown to help with the various conditions. It needs to be medically necessary for insurance to want to cover it. Medical Necessity definitions vary by insurance carrier but most state that the treatment needs to be to help someone recover from an injury or condition that massage therapy can help. It does not (yet and not sure it ever will) cover massage therapy for wellness, maintenance or stress reduction.