Medical Orthopedic Massage Therapy Insurance Information

Please Note: Please note that as of July 1st, 2017, the practitioner has requested removal as an in-network provider from all major medical heath insurance companies effective July 31st, 2017. Since the provider is “out of network,” you will be required to make your payment the same day of service, and you will be provided a superbill to submit to your insurance company. For WA State L&I, no prepayment is necessary because your employer is paying for the treatment. As of July 27th, 2019, the provider has requested removal as an in-network provider of United HealthCare.

Pain to Performance is an In-Network Insurance Provider for Medical Massage for WA State Labor and Industry – L&I.

Pain to Performance is an Out-Of-Network Health Insurance Provider for Medical Massage for Premera, Regence, First Choice, Cigna, Aetna, Kaiser, United Healthcare, and your own personal auto insurance coverage = PIP – Personal Injury Protection.

Prescriptions referrals are “required” for in-network, out of network, PIP, and Labor & Industry coverage. Prior approval is always required, even if your insurance says you do not need it. Some insurances like Regence, Premera, and Group Health now require pre-authorizations too. We love our clients and want to make sure that you do not get stuck with a bill, so please follow these instructions carefully. Reach out to us if you have any questions. Below are the steps you need to take to fully benefit from Medical Orthopedic Massage.

Visit your Washington State primary care doctor, orthopedic doctor-surgeon, urgent care doctor, pain management doctor, chiropractor, or physical therapist.

Make sure that your injuries have been examined and diagnosed.

Ensure that your doctor has written you a prescription with the ICD 10 diagnosis code, frequency (as to the number of sessions per week/month, and duration of time (as to how long such as 12 months or 4-6 weeks). The prescription must be for diagnosis codes reimbursable for medical massage therapy, meaning pain, strains, sprains, and tears.

If using insurance, check to make sure your insurance covers Medical Massage Therapy and how many visits (If not PIP or L&I/Workman’s Compensation).  Some questions to consider are:

• Do you have a Copay or Coinsurance? 
• Have you met your deductible? 
• After meeting your deductible, what is your percent coverage, i.e., 80%? 

We know it is a lot of paperwork but imperative for you to know. After all, you are paying for your insurance. Make it work for you. Nobody likes to get surprised by an unexpected bill, especially when working through injuries and recovery.

Pain to Performance cannot guarantee that your insurance company will pay your bill, so make sure to do your research.

When you are ready, call our office and set up your appointments.

Text, fax, or e-mail your prescription to us before your online intake form. Please get your paperwork to us at least 4-5 days before your desired appointment.

We will pre-approve and pre-authorize all treatments with your “non major medical” insurance company to ensure they will pay the bill.

After each visit, we will submit your claim if we are in-network, if you are using WA State L&I, or if it is a PIP case. If we are not in-network, we will give you a superbill.

If we are in-network for you, it is up to you to make sure you do not double book alternative health care professionals on the same day. Many of us use the same billing codes, and one of us will be denied, leaving you to pay an additional out of pocket fee.

Many times using the term Therapeutic massage vs. Clinical Massage vs. Orthopedic Massage vs. Medical Massage is interchanged. They mean the same thing, just different words to describe them. Below are some interesting scientific research articles on the benefits of Therapeutic Massage Therapy.