6 Tips On How To Maximize Your Health Insurance Massage Benefits

Couple getting a massage
A massage certainly sounds inviting at the end of a long week, whether your days are filled with back-breaking labour or sedentary sitting in an office. Health insurance plans cover massage therapy – do you know how to maximize your benefits?

Massage may very well be the oldest form of medical treatment. For thousands of years, people have sought relief through hands-on therapy and today therapy is available in medical clinics, wellness centers and spas.

Most health insurance plans include coverage for massage therapy, and it may appear straightforward, but some conditions that apply to your claims – so here are some things you should know.

Why get a massage?

Your skin is your biggest organ covering about twenty-two square feet (2 m2) in an adult and accounting for about 16% of your total body weight. It contains millions of sensory receptors that gather information from the outside environment and transmit these impulses to your brain and spinal cord.

Awareness of the mind-body connection is increasingly finding its way into the fields of medicine and integrative health care. Research supports massage as effective in modern neuroscience explorations of how the connection between the skin and the nervous system works and influences our bodies. We know there is a significant relationship between skin-to-skin contact like massage and our bodies processes such as brain development and function, hormonal balance, mood, and behavior.

Massage is skilled therapeutic touch that can facilitate stress relief and relaxation, lower anxiety, and depression, reduce pain, support skeletal and muscular realignment, and promote overall improved well-being. Your touch receptors release endorphins: reducing your stress and making you feel better. That’s why massage works to loosen up muscle knots, treat injuries and also help with managing depression, anxiety, digestive disorders, headaches, and fibromyalgia. It can even help you to cope with chronic conditions like arthritis or a back injury.

Your practitioner must be registered

To get reimbursed for the cost of a massage according to the limits and specifics of your health insurance plan, it must be conducted by an individual registered and/or licensed as a massage therapist in the province in which the services are rendered. It is up to your health plan’s insurer to determine if a therapist’s registration falls under their parameters for massage treatment reimbursement. For example, your practitioner may be an “RMT” noting they are a “Registered Massage Therapist.”

If a therapist registered in one province performs a massage in another where they are not registered, it will not be eligible for reimbursement. If you wish to look up a practitioner in Ontario, you can find the information online at the College of Massage Therapists.

There are some situations where a naturopath may administer a massage. If your plan covers naturopathy, your insurance provider will assess the claim under that benefit. However, if your plan excludes naturopathy, it will not be eligible for reimbursement.

Ortho therapy is a treatment that incorporates massage, kinesiotherapy, joint mobilization, and other care to restore function to the body. This treatment is typically not eligible if performed in Ontario but refer to your policy or call your insurer ahead or ask your therapist before having treatment.

Foot massage

What should be on your receipt?

To assess your massage therapy claims, your insurance provider will require an official receipt that states the:

  • patient’s name
  • date of the service
  • type of service that was rendered
  • length of the massage
  • total cost
  • name of the registered massage therapist

As the insured, you must also fill out a medical claim form, sign it and submit it for reimbursement.

A doctor’s certificate – find out if you need one

Some plans don’t require you to provide a referral from your medical doctor. You can just submit your claim, and that’s it. However, others do require a referral and you will not be paid until that paperwork is received.

Some policies require a renewed referral every six months to a year. Double check your plan’s details or ask your insurance provider directly. Remember, your insurance pays for medically necessary treatment.

The reasonable and customary rate

Massage therapists can technically charge whatever they wish for their services, but your plan may only pay a certain amount per visit and may limit the number of visits per year. Your policy will outline what the limitations are.

If your claim exceeds your insurer’s acceptable rate per hour – for example $200 per hour — the amount you will be reimbursed will be adjusted to meet your insurer’s reasonable and customary (R&C) amount.

There’s also usually a limit or maximum dollar value associated with extended health care benefits that dictates how much you can claim. For example, depending on the plan, you may have $500 annual coverage for massage therapy, but that maximum may be shared with other benefits like chiropractic care or physiotherapy. You therefore may not have the full $500 to use for massage if you want to use the benefit for other health care services too.

You can shop around for the treatments you need: compare costs and you may find a therapist with a more reasonable price. Remember, your health insurance benefit plan may have a per visit maximum and lifetime maximum, so checking around will help you get the most out of your plan.

The acceptable duration for a massage therapy claim

Wouldn’t it be amazing to spend an entire day in the lap of luxury, getting a massage and listening to pan flute music? In theory you could, but your insurance company certainly won’t foot the bill.

Unless your plan explicitly states otherwise, your massage therapy benefit is paid at the R&C rate of one hour per visit. So, if the duration of your treatment is two hours (or four!)  instead of one the extra treatment hours will not be covered. However, if you have a condition that requires extra time you can provide a medical certificate from your physician explaining the reason. Cases such as these are dealt with on an case by case basis and may not be approved.

Paying your therapist

Depending on your insurance provider, it may or may not be feasible to have your massage therapy claims reimbursed to the RMT or clinic directly. Occasionally a plan will allow for what is called “assignment of benefits” in which they will pay the provider of the services directly. You would be required to cover any difference yourself.

Relax, Health Insurance has you covered

Using health insurance benefits can help cover the cost for paramedical practitioners like Chiropractors, Massage Therapists, Physiotherapists, Psychologists and more. Many plans include access to medical professionals for video consultations, eliminating the obstacles of travel and waiting room time delays which can help shorten the cycle between them identifying your health problem and implementing a clinical solution like massage therapy, making taking care of your health more convenient. For more information on your health insurance options at SBIS, click here or give us a call Monday to Friday 8:45 a.m. – 4:45 p.m. Eastern Time at 1-800-667-0429 or 416-601-0429 – we’re happy to help.


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