2013 will be a big year for the massage profession and massage therapists. One of the major things we will have to be working on as a profession is whether or not massage will be covered on health insurance plans in every state under the Affordable Care Act which goes into effect in 2014.
This is what I know right now:
Every state is required to create a health insurance exchange system that will allow people who do not have coverage to get health care insurance. The federal government is giving money to each state to create their exchange systems. States have until Feb 2013 to decide if they want to create their own exchange system. If they don’t choose to do so, they will default to the federally facilitated exchange system. Here is a map of which states are doing what from the National Conference of State Legislatures.
Here is the main section of the law that will allow MT to bill health insurance:
SEC. 2706. NON-DISCRIMINATION IN HEALTH CARE.
(a) Providers- A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.
(b) Individuals- The provisions of section 1558 of the Patient Protection and Affordable Care Act (relating to non-discrimination) shall apply with respect to a group health plan or health insurance issuer offering group or individual health insurance coverage.
There are also other sections that apply to massage.
SEC. 3502. ESTABLISHING COMMUNITY HEALTH TEAMS TO SUPPORT THE PATIENT-CENTERED MEDICAL HOME.
SEC. 4001. NATIONAL PREVENTION, HEALTH PROMOTION AND PUBLIC HEALTH COUNCIL
SEC. 4206. DEMONSTRATION PROJECT CONCERNING INDIVIDUALIZED WELLNESS PLAN.
SEC. 5101. NATIONAL HEALTH CARE WORKFORCE COMMISSION.
You can read them all at www.theintegratorblog.org which is the blog of John Weeks who is also with the The Academic Consortium for Complementary & Alternative Health Care.
There are many things we do not know : How will massage fit into the exchange systems? How will this law affect the current health care plans? I would assume that it would also mean that massage therapists will only be considered if they are licensed as a health care provider. There are also things that can be done to get the insurance commissioners offices to recognize massage. Do we even want to be included in health care? Are we ready as a profession?
While here in WA we already are contracted health care providers and have had many challenges with things like having benefits reduced and also the amount that they pay. One of the problems is that we will have to be much more organized as a profession in order to be able to negotiate with health insurance companies. There are over 300,000 massage therapists in the US which would make an impact if we could all come together over this. The other thing is that this might be happening whether we are ready or not. It is important that we get to the table and start talking to the insurance commissioners and the federal exchange system. If we aren’t there at the table , they will dictate what will happen. It is better to be at the table than what is on the menu.
Contact Your Local AMTA Chapter to see what they are doing and get them working on the issues in your state.
Use this paper created by AMTA WA and submitted to the WA State Office of the Insurance Commissioners to help prove that massage works.
The Integrated Healthcare Policy Consortium (IHPC) is the main lobbying champion for integrative healthcare delivery. The ACCAHC Clinicians’ and Educators’ Desk Reference will help you explain massage to the insurance commissioners.
Update Feb 9, 2013
The Integrative Healthcare Policy Consortium (IHPC) has hired Deborah Senn (who was the past insurance commissioner in WA State who made it so massage was covered under health insurance and made it so massage therapists could be contracted providers) to work to get massage and alternative medicine covered under the new Affordable Care Act.
Blog by IHPC for massage therapists
IHPC for massage therapists Facebook Page
Buy my introductory book on the subject of billing insurance – Insurance Billing 101 for Massage Therapists (in PDF, Paperback, Kindle, Nook) . This book is a general overview of what you will need to know about insurance and get started in the world of billing insurance. In most states, Massage therapists can bill insurance for car accidents and work related injuries and more and more health insurance companies are paying too. You just need to learn the right questions to ask to the insurance companies, doctors, lawyers and clients in order to get paid.
thank you Julie for posting, I had a group disscussion with my students on this topic just yesterday.
your site is very helpful and a great additional resource that every massage professional and instructor should utilize.
Kenneth Pfaff says
Julie, thanks for continuing the conversation about the ACA. As one of the co-authors of the document provided to the OIC and linked above, and as part of my Library’s mission, I stress the importance of being aware of the local and national environment of the profession, up to an including the establishment of trade or peer-review literature reading as part of a normal massage business environment. This could have been a nasty surprise to the thousands of therapists in Washington State billing (or who will ever want to bill) insurance. It’s not done yet! We’ve got to work it. Every day.