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Uniform Medical increases limit to 24 Massages

22 Nov 2021 9:10 AM | Amy Thomason (Administrator)

By Dagmar Growe, LMT

There has been a lot of buzz around the increase of the maximum number of massage therapy treatments allowed through Uniform Medical Plan. Uniform Medical members are calling massage clinics and asking to schedule “their” bi-monthly massage. However, as is generally true, things aren’t as simple as they seem, especially when you read Uniform Medical’s fine print.

First of all, it’s important to note that this change only affects Uniform Medical, not any other plans administered by Regence. Uniform is a self-insured plan which means it can make up its own rules, including offering higher limits on allowed visits.

Second, according to the Uniform Medical Plan(UMP) Certificate of Coverage a prescription is still required. This means a physician’s order for a service (or a procedure) that is needed to treat a specific condition, specified by a diagnostic code. In other words, Uniform continues to require medical necessity in order to pay for treatments. If a future audit finds that massage services were not provided as treatment for the condition indicated by the prescription, the massage therapist might be faced with a demand to repay insurance payments received for those massage treatments.

Unfortunately, the benefits summary is not specific about any of this, physicians frequently provide very general prescriptions at patient’s requests, and massage therapists are left in the uncomfortable position of explaining to patients the unexpected limit of their benefit. Be sure to carefully and correctly document the treatment nature and medical rationale for any massage services you provide, especially for treatments that are reimbursed by health plans. Your treatment records are your best, and likely only defense if you are facing an audit.




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