Navigating the insurance and FSA/HSA waters can be very tricky. Hopefully this will help.
1) Does Medicare cover massage therapy or wellness training? If you have regular Medicare Part A & B (even with a supplement), then the answer is no. Massage therapy, Reflexology, Dry Needling and Wellness Programs are NOT covered.
However, if you have a Medicare Advantage Plan (Part C), then massage therapy MAY be covered depending on your plan. It will require a prescription from your healthcare provider. Reflexology, Dry Needling, and Wellness Programs are typically NOT covered.
Medicare does cover physical therapy. A doctor's referral is required.
2) Can I use my HSA/FSA for Wellness Services? YES, BUT there is a BUT..... In order for you to use your HSA/FSA funds, you will need a Letter of Medical Neccessity (LMN) from your healthcare provider as to why you need the services (it must be needed to treat a specific disease or condition). Here are some examples:
Your doctor writes a LMN for massage therapy to help manage chronic back pain
Your doctor writes a LMN for one-on-one wellness sessions with our physical therapist to help lose 5 pounds and lower blood pressure (Group sessions are generally much harder to be covered)
Your doctor writes a LMN for reflexology as a means to reduce diagnosed anxiety
You just completed physical therapy to reduce fall risk (have a history of falls) and your doctor writes a LMN for one-on-one wellness sessions with our physical therapist to further improve strengthening to maintain low fall risk and independence because the you live alone
LMNs are good for 1 year. If you are using your FSA/HSA, our practitioners will document sessions and provide general assessments to verify services are still necessary.
Failure to have a LMN could result in a 20% tax penalty for FSA/HSA fraud.
You can use your HSA/FSA for physical therapy services and dry needling. A physical therapist can treat you for 30 calendar days without a doctor's referral. (SC State Law)
3) Is massage therapy or reflexology covered under my commercial insurance? Massage Therapy coverage is plan-specific. Reflexology is not covered. You will have to check your benefits from your specific plan. Your plan will most likely only cover a certain number of visits, and/or may only reimburse up to a certain amount.
If it is covered - it will require a prescription from your healthcare provider. A diagnosis code will be required and the massage therapist will be limited to only treating what the provider has deemed medically necessary. So we recommend keeping the diagnosis codes broad such as muscle pain or use multiple diagnosis codes such as low back pain, leg pain, neck pain, etc.
For physical therapy, we are in-network with Medicare, BCBS, and Tricare. You may use your HSA/FSA for out-of-network services.
Dry Needling is NOT covered by any insurance. You may use your HSA/FSA to cover these services.
4) How will my insurance claim be filed? If you would like to use your insurance for reimbursement, we would need a prescription from your physician.
Your massage session will be limited to either a myofascial or prenatal massage. You will be required to pay for services upfront with Joint Effort. We will then provide you with a Superbill that you can send in to your insurance company for reimbursement.
5) How much will my insurance reimburse? Short answer - it depends on your plan. You would have to contact your insurance company to find out the fee schedule for massage therapy.