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Insurance Suggestions

I would like to share with you some of my experience with insurance companies. First, you need to know some general guidelines about medical coverage.
  • Car insurance’s medical coverage usually is $10,000, also called PIP.
  • If you get injured at work, your L&I covers up to 12 or 18 visits of massage therapy.
  • If you are very lucky to have massage therapy coverage in your health insurance it normally covers somewhere between 12 and 20 visits, or even up to 60 visits per calendar year.


Once you are eligible for one of the plans above, it is very important for you to remember that this is YOUR money. It is NOT FREE. You have to be very careful how you spend your money because it is limited either by the amount, visits, or time period. For instance, if you get involved in a car accident, whether it's your fault or not, you usually have $10,000 of medical coverage. Then you go to see a medical doctor or a doctor of chiropractic. They take X-ray’s, then refer you to have an MRI done if it is necessary. You may also be referred to a physical therapist, massage therapist, acupuncturist and/or naturopathic doctor. All of the treatments that you receive will come out of this $10,000. In six to twelve months your $10,000 of medical benefits might have run out. If you are totally recovered that’s great, but what if you aren’t? You can choose to pay for the treatments yourself until you recover, or choose to end treatment and live in pain. If you don’t see significant improvement in your symptoms within 4 weeks, then you should consider another opinion regarding your treatment options. Once again, don’t forget that your benefits are limited by time and amount, so be careful how they are used.

ADVICE:  You always need Doctor's Referral or Prescription for Massage Therapy regardless what the insurance rep or your coverage says.  To protect the Therapist getting paid and prevent you from paying later on with your own money if the insurance company denies and many times they will and here is why.  For a real example, you are using your medical insurance card and your insurance coverage paper and insurance rep say that your plan is a PPO plan and you don't need Doctor's Referral.  It's true that you don't need Doctor's Referral.  But one thing that they will never tell you (not even many healthcare providers know) is you need Doctor's Prescription.  What is the different between Referral and Prescription?  Referral - Tells exactly for how many visits per treating period with specific details of the conditions such as 1-2 visits per week and up to six weeks with massage therapy for the right shoulder strain/sprain.  Prescription - on another hand, only describes the problem such as neck pain and/or back pain (this is all you need). 

The insurance company wants to know why you visiting the massage clinic.  They don't pay for maintenance, relaxation, stress reduction, sore and tightness muscles.  Since Massage Therapists are not doctors, we cannot diagnose what the problem is.  That is why you need someone such as Medical, Naturopath, or Chiropractic Doctor who can diagnose with the condition.  Then Massage Therapist can look and translate the condition into the medical code.  Without the medical code/s, the insurance company will refuse to pay and they have the rights not to pay.  

NOTICE:  At Master Massage Clinic, our policy is if someone using any kind of insurances, the person must have Dr.'s Prescription or Referral or we cannot see them.  And if they forget or don't have the referral or prescription, they have to pay up front with the cash special discount rate.
 

 
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