Common Limits or Requirements for Massage Reimbursements?

[namealreadyinuse]

Our plan does not currently permit many dual purpose items, but we are going to open it up for massages. What types of requirements are normally imposed?

Licensed massage therapist?

Doctor's note?

Should that include Chiropractor?

[Guest Kristine]

You need to get a Letter Of Medical Necessity from a qualified physician. Since Chiropractors are not considered physicians, the letters may not come from them. The letter needs to state the following:

1. A specific medical condition

2. How the massage will help or alleviate the condition

3. The letter must contain the physicians name and address

4. Letter must be signed by the physician

The participant must provide a copy of the letter every time he or she submits a claim for massages. The letter is only good for the current plan year. The participant must request a letter for every plan year.

Our plan does not currently permit many dual purpose items, but we are going to open it up for massages. What types of requirements are normally imposed?

Licensed practationer?

Doctor's note?

Should that include Chiropractor?

[namealreadyinuse]

That is very helpful. Do you specify any limits on types of massages or require specific licenses for the therapist?

[leevena]

Your issues will depend upon what type of a plan you have. To begin with, is it self-funded or insured? Under a self-funded plan you are free to do whatever you want. You can add any provider you wish, you decide on referral or not, you decide payment amounts, etc. Under a fully insured, you now run into possible conflicts with the contract and the network. See Kristines comments for a few of these.

In todays world of increasing health care costs and decreasing benefits, your employer seems to be a nice one to work for.

[Guest Kristine]

Is your plan a FSA or something else?

If an FSA, you need to do all of the above that I listed. The service does not need to be provided by a licensed therapist. It can be from a salon, massage therapist, etc...

Your issues will depend upon what type of a plan you have. To begin with, is it self-funded or insured? Under a self-funded plan you are free to do whatever you want. You can add any provider you wish, you decide on referral or not, you decide payment amounts, etc. Under a fully insured, you now run into possible conflicts with the contract and the network. See Kristines comments for a few of these.

In todays world of increasing health care costs and decreasing benefits, your employer seems to be a nice one to work for.