All About Insurance

Medical Massage is massage therapy that is prescribed by a physician and deemed "medically necessary". Insurance is no magic bullet, but sometimes it can reduce your cost of care. Here we hope to answer some of the most common questions about this complex topic.

  1. What is Medical Necessity?
  2. Do I need a prescription?
  3. Does Turning point Wellness accept insurance?
  4. What is a Superbill?
  5. How much is Medical Massage?
  6. What about FSA/HSA accounts?
  7. Can I use my HMO insurance?
  8. Is Turning Point Wellness in network with any insurance companies?
  9. Why does medical massage cost more?
  10. How do deductibles, copays, and co-insurance work?
  11. What are the limits on number of visits?
  12. I was in a Car Accident. Will their insurance cover massage?
  13. What about Workers' Compensation?
  14. Do you work with accident/injury claims?

Detailed information:

  1. What is Medical Necessity?
    A doctor decides if a treatment is medically necessary via diagnosis. A letter of medical necessity or prescription serves as proof that a primary care provider (PCP) has determined that the massage is necessary. Massage therapists are not licensed to diagnose conditions. All insurance reimbursement and some FSA/HSA payments require proof of medical necessity.
  2. Do I need a prescription?
    Yes. A prescription/referral proves medical necessity and will be needed for any substantiation with your insurance company or FSA/HSA plans. You can download a convenient form for your doctor here that will help ensure the prescription is written in the most universally accepted way.
  3. Does Turning point Wellness accept insurance?
    It's actually not up to us, but your plan. We do NOT directly bill your insurance. Some plans will reimburse you for our services, some will not. You're out of luck with an HMO. Not all PPO plans or companies cover massage therapy and believe it or not, even those that do won't always pay for a massage therapist to do it! You'll need to check your eligibility first. You can call your insurance company and ask them if they will pay for a licensed massage therapist to perform myofascial release (code 97140) and/or massage therapy (97124) that has been prescribed by a doctor. Some companies reimburse one code and not the other or at different rates. Please note that there are never any guarantees with insurance companies and you are responsible for any payments for services that insurance won't reimburse. We can assist with referral to a chiropractor or doctor for diagnosis if needed.
  4. What is a Superbill?
    A superbill is documentation that we provide for medically prescribed services for the patient to submit to insurance for reimbursement. The patient must pay for services at the time of service and then it is up to the patient to file their claim with their insurance carrier to be reimbursed. We do not bill insurance companies directly for medical services. Because you're doing the legwork, superbilling allows us to keep our medical rates much lower.
  5. How much is Medical Massage?
    Medical massage is slightly more expensive than non-medical due to the increased overhead of documentation, communications, and providing your superbill. Please see our services page for our medical rates.
  6. What about FSA/HSA accounts?
    You can use your FSA/HSA plans to pay for massage (even if your insurance won't cover it) as long as you have a prescription/referral that proves medical necessity. You will need the prescription or a referral written by your doctor as well as the superbill we provide to substantiate the payment. Make sure you plan for your massage therapy treatments when you set up your plan withdrawals during your open-enrollment period each year. Massage therapy is also a great way to use remaining FSA funds before they expire at the end of the year.
  7. Can I use my HMO insurance?
    Probably not, but you'd have to call them directly to ask. HMOs only work with providers within their network and Turning Point Wellness is out-of-network with all insurance, including all HMOs and PPOs.
  8. Is Turning Point Wellness in network with any insurance companies?
    No.
  9. Why does medical massage cost more?
    Medical massage requires more administration, documentation, , communications, and potential liability than non-medical massage.
  10. How do deductibles, copays, and co-insurance work?
    A deductible is an amount that you are responsible for before your insurance covers anything at all. If you have not yet met your annual deductible, you will be responsible for 100% of the cost of treatment without any reimbursement. Copays and co-insurance are also amounts that you are responsible for and will not get reimbursed for. You may use FSA/HSA plans to cover deductibles, copays, and co-insurance.
  11. What are the limits on number of visits?
    Insurance companies often limit the number of visits or dollar-amounts of physical medicine treatments. Unfortunately, massage, chiropractic, physical therapy, and acupuncture all draw from the same physical medicine pool of money. Occasionally, you may be able to request more visits from your insurance company.
  12. I was in a Car Accident. Will their insurance cover massage?
    Always call us for a quick consult if you've been in a car accident. Auto insurance is actually one of the easiest insurances to work with. We do recommend getting medically evaluated with a doctor if there are even minor symptoms following an auto accident. A medical referral/prescription from a doctor reduces some potential problems from the insurance company and is definitely recommended if treatment will extend beyond 4-6 sessions. You will pay for your sessions yourself and receive a superbill to send to the insurance.
  13. What about Workers' Compensation?
    Turning Point Wellness is not taking Workers Comp cases at this time.
  14. Do you work with accident/injury claims?
    We can take a limited number of accident claims under an attorney lien at any given time and must limit the amount of outstanding balances due to risk of non-payment. Call us for details.