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Massage Therapy: Why Something So Fantastic Has to Be Reasonable and Customary

massage therapy man and woman relaxing in bamboo spa.
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. And massage therapy isn’t only perfect for relaxation! It is helpful for treating injuries, and also depression, anxiety, digestive disorders, headaches, fibromyalgia and many other ailments.

The after-effects are wondrous, giving you relief from the stresses of life. To some, massage therapy is a real luxury to be paid out of pocket, while others are fortunate to have massage therapy covered under their medical insurance plan.

Massage may very well be the oldest form of medical treatment. For thousands of years, people have sought relief through hands-on therapy. People used to convene in bathhouses and socialize while they were being rubbed down. We have come a long way since then. Gone are the seedy massage parlours, and in their place are luxury spas, clinics, and wellness centers.

There is a huge market for massage treatment, as it is the most sought-after benefit for insurance coverage. Your skin is your biggest organ, and you cannot afford to mistreat it. Your touch receptors release endorphins; reducing your stress and making you feel better. Loosening up muscle knots and relieving inner tension are other important benefits.

Healthcare plans that include massage therapy may appear straightforward, but some unwritten conditions apply to your claims. Unless your plan specifically states otherwise, there are limitations to how much you can claim at a time. Any service must be of a “reasonable and customary” nature, meaning that it’s not sensible to submit a claim for a two-hour massage when a one-hour treatment would usually be enough.

Additionally, the services must be performed by a qualified practitioner. Consult your benefit booklet and read the provisions for massage therapy coverage very carefully to avoid confusion. Here are six things you need to know about having massage therapy covered under your plan.

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Your Practitioner Must Be Registered

You may notice on your massage therapy receipts that the practitioner lists “RMT” after their name, meaning “Registered Massage Therapist.” They must be registered as a massage therapist in the province in which the services are rendered. If an Alberta-registered therapist performs your massage in Ontario, it will not be eligible for reimbursement.

If you wish to look up a practitioner in Ontario, you can find the information online at https://registrants.cmto.com/webclient/registrantdirectory.aspx. For Alberta, you must confer with the Massage Therapist Association of Alberta. Calling the therapist ahead of time to verify can help also, but check with your insurance provider as well, just in case.

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.

kid in rehabilitation

Orthotherapy 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 brochure to be certain.

What Should Be On Your Receipt?

To assess your massage therapy claims, your insurance provider will require the following:

  • official receipt stating 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

A cash register receipt that only shows the total cost is not sufficient as they do not list all of the above information. It’s not up to the insurance provider to contact the therapist for a new receipt. You’re responsible for all paperwork that you submit. You must also fill out a medical claim form with the plan holder’s original signature.

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 to dissuade people from taking advantage. Your policy will outline what the limitations are.

If your claim exceeds the proper rate per hour, it will be adjusted to meet the R&C amount. If your plan simply states that it will refund a certain number of visits per year with no dollar maximum, R&C rates will still apply per treatment.

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.

relaxing and wellbeing

Unless your plan explicitly states otherwise, your massage therapy benefit is paid at the R&C rate of one hour per visit. However, if you have a condition that requires extra time you must produce a medical certificate from your physician explaining the reason. Cases such as these are dealt with on an as-needed basis and may not be acceptable.

Paying Your RMT

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. Your plan will not pay for any future treatment, so ensure that claims are always filed after the fact.

The massage therapy benefit is not only a perk but a privilege. How lucky we are to have this valuable and enjoyable service covered by medical insurance. Now that you know everything about your massage claims, you can relax that much more.

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