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Please note that I am currently NOT accepting new insurance patients. 

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We are credentialed with Regence Blue Cross Blue Shield only.  If you have any insurance other than Regence and wish to seek reimbursement from them for our treatments you will pay us at the time of service and send in to be reimbursed by your insurance later.  We will furnish you with the appropriate paperwork and a superbill, which you would send in to your insurance company in order to be reimbursed at the out-of-network rate. 

~For all clients using their health insurance, we DO require that you have a prescription for massage from your doctor, regardless of whether your plan says you need one. Your prescription must include the proper ICD-10 diagnosis code/s and the number of sessions prescribed. This includes submitting for reimbursements from insurance companies other than Regence~

Pre-Authorization

Most Regence plans require pre-authorization for massage therapy treatment. Please check with your insurance company to determine whether this affects you and what it will mean for our work.  Please know that Regence changes this information from time to time and they can impose the requirement for Pre-Authorization at any time.

Regence Blue Shield requires pre-authorization for physical rehabilitation services, including massage therapy, in many of their plans.  

This does not effect you if you are an employee at the Gates Foundation, Seattle Children’s, King County, Snohomish County, or have the Uniform Medical Plan (University of Washington and associated hospitals).  

 

The process for pre-authorization looks like this:

 

  • You come in for an initial assessment and treatment.

 

  • I submit for pre-authorization online to eviCore.

 

  • If you have not yet received any physical medicine treatments for the year, you will usually be granted pre-authorization for 4 sessions (60 minutes each) automatically, to be used within 30 to 45 days. This includes the initial treatment and assessment. If we are not able to use all of the visits within the given amount of time, eviCore will allow one (1) extension of up to 30 days.

 

  • After 4 sessions, if you still feel that you have need of treatment, an updated treatment request is sent showing the progress you have made since the start of care, and outlining our treatment plan going forward. eviCore will then either (a) grant a continued set of 2 or 3 sessions or (b) deny further treatment and recommend a different approach with a different specialty. If you believe that your condition will likely resolve in the next 2 or 3 visits, then we can appeal their decision. If improvement has been slow, we are not making progress within the expected model, and they deny a second time, then we will conclude treatment on the issue and refer you to another specialty and have you try something else for a time.

 

Here is a chart showing their progress expectations:

eviCore Progress Expectations

 

Medical Necessity

In order for massage to be covered by your insurance, you will need a prescription from your doctor, even if your insurance plan says you don’t.  It is outside of my scope of practice to diagnose your injury, and we must have a diagnosis code in order to bill insurance and be paid.  Therefore, you will need a prescription.

Be aware that insurance companies are fairly rigid in their definition of “Medical Necessity”:

“Benefits for inpatient and outpatient rehabilitation therapy services (such as massage therapy) are provided when such services are medically necessary to either restore and improve a bodily or cognitive function that was previously normal but was lost as a result of injury, illness or surgery.

Loss of function generally means a joint that doesn’t have full range of motion or full strength, or pain that prevents you from your activities of daily living.

Insurance companies are not interested in treating chronic pain syndromes. They want to see results. If the treatment isn’t showing significant improvement of 75-90% within 6 -10 sessions, they will likely deny further treatment, even if you have not reached the benefit limit in your insurance plan.