fbpx

Medical Insurance FAQs

We truly are happy to work with you and your insurance company to provide you with an exceptional massage experience. Major Medical insurance coverage can be really confusing, especially when it comes to massage. Below is information to help you understand your role and responsibilities as well as how we can support you in working with your insurance company.

Your role

  • You are our client. We are happy to bill your insurance company for your services, however, you are ultimately responsible for the payment of your account.
  • Please verify your benefits prior to your visit with us by calling your insurance company directly.
  • You are responsible for understanding the specifics of your insurance benefits. You may end up paying more out of pocket by not fully understanding the details of your insurance.
  • Co-payments, co-insurance, and deductibles will be collected at the time of your service. If you are not prepared to pay, we may ask you to reschedule your visit.
  • If you do not have coverage or have insurance that we are not contracted with, you will be required to pay in full at the time of your service. 
  • Please call us to verify if we are contracted with your insurance. Also note that some insurance companies have closed networks and will not add new providers.

Our role

  • As part of our service to you, we can help you maximize the benefits of your insurance plan and minimize your out-of-pocket payments.
  • We cannot determine the benefits and specifics of your insurance plan, and a benefit quote from your insurance company is not a guarantee of payment. 
  • Each one of our team members is individually credentialled with specific companies. 
  • If you pay out of pocket but would like to self-submit a medical claim for possible reimbursement, we are happy to provide an itemized bill after you pay in full.

Common Insurance Questions

 

Do I Need A Referral To Get My Treatment Covered By Insurance?

A referral from a doctor is required for all medical massage treatment. Some insurance companies do not require a referral; however, all claims require an ICD-10 diagnosis code and it is outside of the scope of practice for massage therapists to diagnose in the state of Washington.

 

Can I Receive Treatment For Injuries that occurred In An Auto Accident?

In order for us to bill personal injury protection insurance for an auto injury, you must have an open and active claim. We do not bill third party insurance (the other driver’s insurance) so you will need to confirm that you have Personal Injury Protection (PIP) on your policy.  We may also require an attorney to be involved depending on the complexity of the case. If you do not have one we can provide referral options for attorneys that we have currently worked with.

 

What Is A Co-Payment?

Your insurance may require a co-payment for your visits. A co-payment is a fixed dollar amount that you are required to pay (and we are contractually required to collect) at the time of your visit.

 

What Is A Co-Insurance?

Once you have personally paid for your medical services up to your annual deductible amount, your insurance plan will begin paying. If your plan has a co-insurance, it will require you to pay that percentage amount for those services you have received in excess of your deductible. For example, your plan has a $1,000 deductible and a 20% co-insurance. You receive an MRI scan costing $1,500 at the beginning of the year. Your plan would require that you pay the first $1,000, plus your co-insurance of $100 (20% of the amount over the deductible, i.e., 20% of $500).

 

What Is A Deductible?

Your insurance plan may require you to personally pay for medical services you receive, starting at the beginning of each calendar year, up to a certain dollar amount. This amount is called your “annual deductible.” For example, if your plan has a $750 annual deductible, you are required to pay the first $750 each year for medical services you receive, after which your plan begins paying. The deductible is applied once each year for all medical services, including specialist visits, outpatient services, durable medical equipment, etc. It may also include primary care visits depending on your coverage.