Features Insurance Management
Insurance Coverage for Massage Therapy

Massage therapists rely heavily on various types of insurance coverage to fund care for patients. Employee health benefit plans, claims for auto insurance and worker’s compensation are all potential sources of funding for massage therapy treatment.  In a survey commissioned by the College of Massage Therapists of Ontario, 75 per cent of patients or clients use employee workplace benefits to pay, or partially pay, for their care.

With job-related stress accounting for an estimated $16 billion in Canada ($300 billion in the United States) and repetitive strain injuries (RSI) estimated to affect one in 10 Canadians, massage therapists have an opportunity to position themselves as allies with industry in keeping claims for workplace injury – and ancillary costs in lost workdays, turnover and employee dissatisfaction – down.

Despite the impact of these workplace-related illnesses, many employee benefit plans are being scaled back. Employers are wanting reliable outcome measures and proof that their invested dollars are yielding healthier, more productive employees. Coupled with an increase in massage therapy insurance fraud, RMTs are at risk for losing a major source of funding for patients.

Report from the Field
I posed the question on Facebook, “Have your workers-with-benefits changed their utilization of massage therapy?” Respondents shared the following:

• EHBP (employee health benefit plan) claim adjudicators are calling to confirm if massage treatments indeed were provided and received. Some are asking for formal treatment plans.
• EHBP brokers merge coverage for several disciplines of what was previously an allowance for each discipline/service provided.
• Insurance coverage per session is capped, causing claimants to examine how to pay for care and forcing RMTs to consider changing their service fees and delivery models.
• Patients/clients are staying within bounds of EHBPs, reporting less discretionary income in a down economy to spend on paramedical care.
• Claimants want practitioners to direct-bill the insurer, instead of paying out of pocket and waiting for reimbursement.
• With the rising cost of claims/benefits used, employers may resort to offering raises or other incentives in lieu of providing benefit plans.
• RMTs are being asked for printed invoices and statements; written receipts are no longer accepted.
• One RMT shared that her name and registration were used fraudulently by another health-care provider. This RMT has had problems ever since with billing a major insurance carrier.
• Claims/online billing for non-commercial (home-based) practices are being denied; apparently insurers suspect home-based practices perpetuate a higher instance of fraud.

Some claimants require a paper trail when it comes to visa/debit card and can no longer use cash to pay for therapy.

A claims adjudicator told an RMT some claimants are committing fraud themselves, submitting bogus receipts with RMTs’ registration info and forging signatures. (Hence the requirement for printed statements.)

Some insurers have antiquated forms ­– RMTs are challenged to find proper forms.

Some RMTs expressed suspicion that insurance claim processors and policy makers purposely put barriers in place to reimbursement of claims, discouraging practitioners or claimants from submitting claims or seeking reimbursement.

It appears insurance companies are tightening anti-fraud practices and, while certainly necessary, this has clear implications for the small, sole-practitioner practice, especially if working from a home-based office.

Threats to Employee Health Benefit Plans

Recession plus surplus workers-to-jobs
Employee health benefit plans available to post-Second World War baby boomers were used to retain skilled workers at a time of skilled-worker shortage and surplus jobs.  Massage therapy practitioners, as well as those working in chiropractic, dental, physiotherapy and other health disciplines, benefit from this generous source of funding. In the current North American recession, there is a surplus of workers and not enough jobs. Employers needn’t offer benefits to retain workers.

Which services should be covered?
Employee benefits have been used to supplement salaries and retain employees, but tangible cost-savings regarding the capability of paramedical services getting injured workers back to work faster are in question. Reporting on employee use of workplace benefits, Danny Peak, senior manager of Private Payers and Strategic Partners, describes results from the Safoni Aventis Healthcare Survey 2011, noting, “Plan members and plan sponsors alike recognize the value of health benefits, yet we appear to be standing on a precipice. On the one hand, we are on solid ground with respect to traditional benefits, such as drug and dental, which seem to deliver an immediate return. The growing availability and utilization of paramedical services suggest an increased understanding of the value of longer-term, more holistic self-care. Perhaps most significant is the emergence of the workplace as a viable, accepted platform for health education, maintenance and promotion.

“On the other hand, ongoing challenges threaten to throw us off balance. The pressure of containing costs makes it difficult to maintain plan designs, let alone explore new approaches to employee well-being. Despite growing evidence of their benefits, workplace wellness programs suffer low participation rates and very few plan sponsors measure ROI (return on investment) in a rigorous way.

“Employers lack systems to track workplace programs and only a handful among the leading organizations are aligning workplace health programs with a broader goal, such as human capital management or workforce productivity. Poor organizational health, particularly stress in the workplace, casts a shadow over employee engagement. Last but not least, baby boomers have just begun their encounters with chronic disease – and too many are unprepared for, or even unaware of, their responsibilities in preventative care and chronic disease management. Similarly, only a minority of employers are seeking out measurement and support tools in chronic disease management.”

It’s evident that, despite billions of dollars spent by employers, there’s been little proof-of-benefit to financing the invoices of numerous practitioners all billing against generous employee health benefit plans.

Practitioners must do their part to show relevance of care through proper outcome measures and must encourage their associations to push for independent research to prove that paramedical interventions make a real difference to industries in cost savings and more productive workers.

Insurance Fraud Sounds a Death Knell
In 2010, CBC went undercover to report on a spa writing legitimate RMT receipts for illegitimate services. With hidden-camera in place, CBC showcased the shady practices apparently epidemic in the spa industry. Insurance fraud does not bode well for a profession already on the ropes for insufficient evidence-based practice and lacking equivalent education (i.e., degree-level program) compared to other health disciplines.  With a tightening of dollars in a recessed economy, massage therapy associations must cultivate credibility with the insurance industry.

Brenda Locke and Lori Green – executive directors of the Massage Therapists’ Association of British Columbia and the Massage Therapist Association of Saskatchewan, respectively – have made it their mission to address the insurance industry’s concerns about fraudulent claims for massage therapy care. On behalf of the Canadian Massage Therapist Alliance (CMTA), they have attended the Canadian Life Health Insurance Association (CLHIA) conferences to foster relationships and improve credibility of the massage therapist profession in the eyes of the insurance industry. What began as an adversarial situation has now become an opportunity for consultation and collaboration.  Advocating for continued insurance coverage for massage therapy care is just one example of the benefit of a national massage therapist alliance.

There is a Bright Spot!
Benefit plans are seen by employers as an expense, with little accountability by practitioners to prove cost-savings and higher quality of life and productivity for workers. A real threat exists in that massage therapist insurance coverage in employee benefit plans, auto insurance and worker’s compensation claims are at risk.

RMTs and their professional associations need to reframe their services as an investment in improving recovery from workplace accident claims, reducing employee turnover and other negative costs associated with job-related stress and workplace-related musculoskeletal disorders and assist the recovery of the North American economy and its businesses. 

Only then can a clear argument be made to keep massage therapy on the list of employee benefits, bypassing traditional health care coverage and proving savings to a business’s bottom line.

Donald Q. Dillon is a practitioner, author and adviser to massage therapists. Find him at DonDillon-RMT.com