By: Dagmar Growe, LMT, WSMTA Support Group Moderator

There is a lot of confusion surrounding federally regulated health plans. The Every-Category-of-Provider statute requires that insurers

must not exclude any category of providers licensed by the state of Washington who provide health care services or care within the scope of their practice for services covered as essential health benefits (WAC 284-170-270). Since this is a state statute, it does not apply to anything which is regulated by federal law. This means that massage therapy benefits can either be excluded by federally regulated health plans, or be limited by any number of arbitrary rules the plan chooses. Because the customer service representatives are generally not very forthcoming with information, it is easy to end up with unpaid claims.

This article aims to shed some light on the different types of federally regulated plans and what to be aware of.

1. Federal Employee Health Plans (i.e. US Postal Workers Health Plan): These never cover massage therapy. However, I have been told otherwise by a customer representative, just to be told later “only if performed by a PT”.
   
   

2. Self-Insured Plans: Large employers or associations like trade unions may opt to create a trust fund for health care expenses, rather than to buy coverage from an insurance company. However, they may then hire an insurance company to administer the trust fund. The best-known example of this is Uniform Medical, which is a self-insured plan for WA State employees that is administered by Regence Blue Cross. Many Premera plans also fall into this category. These plans are regulated by ERISA (Employee Retirement Income Security Act of 1974, a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to protect individuals in these plans). These plans may opt to provide massage therapy benefits, likely because of customer demand, but then apply additional rules that are generally not volunteered by customer service representatives. Here are some examples: “Yes, we cover massage therapy, but only if performed by a PT; but only if billed through a chiropractor, PT or MD office; but only if part of a PT treatment plan and the PT has to bill first”. Additionally, these plans may offer ridiculously low reimbursement rates or limit the number of units covered per treatment to less than 4. 
   
   

3. Military Healthcare: Tricare started offering massage therapy benefits a few years ago. This is a voluntary benefit. Other military healthcare systems do not cover massage therapy to my knowledge.
   
   

4. Medicare: Medicare does not cover massage therapy. However, many Medicare Advantage plans will, although it seems the number of plans that do is declining. Do not assume that because a patient had massage benefits last year, they will this year! It is standard practice for Advantage plans to require a medicare denial before covering remaining expenses. The large insurance companies generally know that massage therapy is never covered, and that massage therapists are unable to obtain a denial, and do not ask for this. Some insurances (or some of their staff) do not understand this, and insist on the denial. In this case filing a complaint with the Office of the Insurance Commissioner will be helpful.

Delegating the research regarding plans to patients will not work, as it is important to ask the right questions. It may be helpful to ask if patients have had massages covered by their insurance before, but it will not be a guarantee that a claim will be paid.

Have questions or just want to understand more about how these programs impact your 

work? Join WSMTA Support Groups! It's a welcoming space to connect with fellow massage therapists, share insights, and get the answers you’ve been looking for. Whether you're new to the field or a seasoned pro, you're not alone—we’re navigating it together.