RMTs and insurer relations – resource restraints likely to come?
The relationship between massage therapists and insurance companies is historically tenuous. Insurers have positioned themselves as guardians of health care spending for their customers and appear critical of the efficacy of massage therapists and the value of dollars spent, sometimes denying claims, questioning outcomes, and crediting only “short-term pain relief.”
By Don Quinn Dillon
Massage therapists regularly observe positive and lasting results from their applications. Denied provincial health funding for services, practitioners rely heavily on employee health benefit plans to finance care. Given this critical relationship, it’s worth considering what a change in insurance coverage for massage therapy services would mean for practitioners, and whether they can work with insurers to preserve quality of care.
Greenshield Canada (GSC) – a not-for-profit insurance company offering dental, drug and paramedical coverage for its customers – posted “Elephant in the (Waiting) Room?” in November 2018. In the post, GSC bemoaned the high cost of common pharmaceutical claims, and stated hard choices would need to be made. GSC presented a moral argument: Would customers be willing to forgo services perceived as uncritical – such as massage therapy – so Greenshield could afford to reimburse customers for these expensive drug claims?
Listen to “On the Table” episode one, where we talk with Andrew LeWarne (RMTAO) about improving insurer relations
Greenshield acknowledged massage therapy is one of the most claimed services, yet provides only “short-term pain relief, and questioned if massage therapy outcomes were any better than autonomous activities such as practicing yoga, going for a walk, or “taking a nap.”
In an October 2018 press release, GSC proposes dropping massage therapy as part of a SmartSpend initiative. This may signal a shift by insurers to offer a basic basket of services at attractive pricing, with more comprehensive plans – which may include reimbursement for massage therapy services – at progressively higher price points. If employers forego the higher insurance premiums of more comprehensive insurance products in favour of a trimmed-down version, more and more working-class citizens would be forced to pay out-of-pocket for MT care.
Reactions by massage therapists on social media express incredulity: “Don’t those insurers know what we do?” Some practitioners question the motives of insurance companies supporting pharmaceutical interventions when less invasive, lower risk applications of massage therapy may do more good. Some condemn insurers for soliciting practitioner ratings, perhaps an attempt to identify and work exclusively with preferred providers, thereby increasing treatment plan control and exerting downward pressure on service fees. Some question the qualifications of claims adjudicators regarding treatment plan approval or denial. Others blame practitioners themselves for creating this vulnerability…our profession demonstrates a low level of research literacy, is ill-organized and politically-adverse, and struggles to generate sufficient statistical proof of positive outcomes in soft-tissue rehabilitation.
Massage therapists and insurers have different objectives, which strains the relationship. For the insurer, it’s a limited pie – they collect premiums, pay out salaries, operations and shareholder dividends before claims. The more claims made, the less insurers have for operations and growth. We can expect to see more control exerted by insurers. Like it or not, we need to work with them if we wish our services reimbursed. This is only the author’s speculation, and an effort to generate discussion, but here’s what practitioners might expect from the insurance industry:
We can expect Greenshield Canada and other insurers to offer multiple-tiered insurance products, increasing in coverage but also cost. Employers faced with this choice may choose to lower premiums, and increase basic-basket plans, significantly affecting insurance reimbursement for massage therapy services.
Insurers hold a gatekeeper position for funding services like massage therapy not covered by provincial health care plans. Insurers will leverage this position to force practitioners to justify reimbursement, produce outcomes that demonstrate value-for-dollar, and prove relevance and cost-savings compared to the wide assortment of health care options available.
Insurers may exert additional controls – session duration, body areas treated, maximum amount paid/session and maximum number of sessions allowed per annum.
Insurers will increasingly ask “Is your application more cost-effective or valuable than the alternatives?”
We can and should work collectively to improve insurer relations, while considering how to work with the resource restraints likely to come.
Donald Quinn Dillon is a practitioner, author and practice coach. Find him at DonDillon-RMT.com.