Massage therapy is often seen as a luxurious treat, but for people dealing with persistent muscle soreness or those recovering from an injury, it can be a medical necessity. However, the cost can add up quickly, especially in clinics that provide high-quality care. How do you get insurance to cover massage therapy? You can do so by following these steps.

1. Review Your Health Benefits Package

Do this before you visit a doctor or a massage therapist. Find your “Summary of Benefits and Coverage” and the more detailed plan contract on your insurance provider’s online portal. Use the search function — or Ctrl+F — in these documents and type terms, such as “massage therapy,” “manual therapy” or “physical medicine.” 

Note any sections that describe coverage or exclusions. Don’t worry if you don’t find something. Many large insurance providers don’t cover massage therapy at first glance, but they may do so once it’s medically necessary. 

2. Call Your Insurance Provider

Many insurance companies only view massage as most beneficial during the acute phase of treatment, rather than as an ongoing therapy. Call the member services number on the back of your insurance card and ask the following questions:

• Does my plan cover massage therapy under any circumstances?
• Do I need prior approval before starting the treatment?
• Is there a limit on the number of sessions covered per year or per condition?
• Are certain body regions excluded from coverage?
  

3. Obtain a Letter of Medical Necessity

Get a formal letter of medical necessity (LMN) from a specialist, like an orthopedist. They can help pinpoint the condition that would benefit from massage therapy. The required information depends on the insurance company’s requirements, but a document that indicates the diagnoses, prescription details and medical rationale should be sufficient.

Ask your physician to include the specific type of massage, how often you should receive it, how long your treatment should last and the Current Procedural Terminology code. Taking these steps helps ensure you get the care that’s best for you.

4. Find a Licensed and In-Network Provider

Not all massage therapists can qualify for your insurance claim. Ensure the therapist is a licensed massage therapist (LMT) in your state, as this is often required for billing. Visit your insurer’s directory to find an LMT who is in-network. Since some directories can be out of date, you should also call the professional’s office directly to confirm their network status.

Ask if they have experience with billing your health insurance company. Working with someone familiar with the process can help prevent administrative hassles and ensure your claim goes smoothly.

5. Secure Pre-Authorization

Many insurers require approval before you start treatment. Either you or your LMT’s office must submit the LMN and the proposed treatment plan to your insurance company. It’s a good idea to wait until you’ve received confirmation before moving forward with treatment.

Occasionally, pre-authorizations might be denied. A study found that 51% of insured adults who were turned down reported that the appeal process was somewhat or very difficult. While this can feel discouraging, having the right support, resources and information can make a big difference.

6. Undergo Treatment and Manage Billing

To ensure insurance covers massage therapy, ensure the billing code matches the one on your prescription. Maintain a folder with copies of your LMN, the pre-authorization approval, massage appointments and any payments or explanation of benefits (EOB) statements you receive. The EOB is a statement from your insurer that breaks down how a claim was processed.

Some clinics offer direct billing to insurance providers, while others provide “superbills” for clients to submit to their insurance for reimbursement. Keeping a simple list of your appointment dates can be helpful. This way, you don’t have to rely only on your insurer’s records.

What to Do When Your Claim Is Denied

Finding out that insurance won’t cover your medical massage therapy can be frustrating, but it’s not the end of the road. Here are various ways to handle such rejection.

Identify the Reason for Denial

The EOB usually contains a reason for denial. The most common reasons are:

• Lack of medical necessity
• Service is not a covered benefit
• Missing or invalid pre-authorization
• Claim containing incorrect or incomplete information

File a Formal Appeal 

If you disagree with the decision, know that you have the option to appeal. Submit a formal written notice within the time frame specified in the denial letter. Include your original LMN and other supporting documents that might strengthen your case.

Explore Tax Strategies

If your appeal is denied or seems unlikely to succeed, you can still make your treatment more affordable by paying for it with pre-tax money. You can use the funds in your health savings account, health reimbursement account or medical expense reimbursement plan to pay for your massage therapy.

Try At-Home Solutions for Muscle Relief

While waiting for your appeal, you can take control of your health with effective at-home tools and techniques. A self-massager can help release stiffness and tension in problem areas like the shoulders, back and legs. Following guided stretching routines on YouTube can also help relieve pain.

Get Muscle Relief Anytime, Anywhere

Understanding how to get your insurance to cover massage therapy is essential to ensuring you get the care you need. Whether your claim is approved or not, know that there are still ways to support your muscle health. Invest in a self-massaging tool to help manage discomfort wherever you go. Our team is always here to help you find the right solution for your unique needs.