Depending on your state and your plan, you may have benefits that might help. You will usually be given an Enrollment Guide or a Summary of Coverage. These outline your coverage and tell you what your options are.
The list below outlines mandatory Medicaid benefits, which states are required to provide under federal law, and optional benefits that states may cover if they choose.
Inpatient hospital services
Outpatient hospital services
EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
Nursing Facility Services
Home health services
Rural health clinic services
Federally qualified health center services
Laboratory and X-ray services
Family planning services
Nurse Midwife services
Certified Pediatric and Family Nurse Practitioner services
Freestanding Birth Center services (when licensed or otherwise recognized by the state)
Transportation to medical care
Tobacco cessation counseling for pregnant women
Speech, hearing and language disorder services
Respiratory care services
Other diagnostic, screening, preventive and rehabilitative services
Other practitioner services
Private duty nursing services
Services for Individuals Age 65 or Older in an Institution for Mental Disease (IMD)
Services in an intermediate care facility for Individuals with Intellectual Disability
State Plan Home and Community Based Services- 1915(i)
Self-Directed Personal Assistance Services- 1915(j)
Community First Choice Option- 1915(k)
TB Related Services
Inpatient psychiatric services for individuals under age 21
Other services approved by the Secretary*
Health Homes for Enrollees with Chronic Conditions – Section 1945
1 - Identify a condition or injury that can benefit from medical massage. In order to prove medical necessity for a massage, you must have a recognizable health condition that may respond to massage in a positive way.
2 - Check insurance rules. Before proceeding with a request for a physician referral for a massage, check to see what the actual rules are for your insurance policy.
Consider whether or not a referral will result in coverage. Often, even if you have a referral, other coverage limitations may apply. Read the policy document thoroughly to make sure that this is not the case.
Understand any exclusions or limitations specifically mentioned in the policy. Another stumbling block for getting medical massage covered is when it is included in exclusions, along with chiropractor visits and other specific types of treatment.
3 - Talk to your primary care provider. In many HMOs and other health plans, this doctor is the one who must authorize the referral.
Discuss medical necessity with the doctor. Figure out how that medical professional will diagnose a condition that can formally necessitate medical massage.
Ask the doctor about what kinds of other treatments go along with medical massage. One way to get a better chance of successful coverage is to combine medical massage with other types of treatments. Ask about how a holistic treatment plan can help provide better rehabilitation or recovery while legitimizing the use of medical massage within a greater context.
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