Billing Insurance for Massage Sessions: Letters of Medical Necessity, Referrals, Prior Authorization — and How Your Insurance Actually Pays

Insurance paperwork can feel like learning a new language, right? If you're using insurance for massage therapy, it helps to know a few key terms. Today we’re breaking down Letter of Medical Necessity, Referral for Care, Prior Authorization, plus the basics of deductibles, co-insurance, and co-pays — in plain English.

Letter of Medical Necessity

A Letter of Medical Necessity (sometimes called an LMN or LON) is a note from your doctor, chiropractor, acupuncturist, or naturopath that says, "This person needs therapeutic massage for a medical reason." Insurance companies usually require this letter to make sure the massage is part of a treatment plan, not just for relaxation. Think of it like a permission slip saying, “Yes, they really do need this care.”

Referral for Care

A Referral for Care is when your primary care doctor or another provider sends you to a specific specialist (like us!) for treatment. Not all insurance plans need referrals, but some do. It’s basically a map — your doctor pointing you to the right place to get the help you need.

Prior Authorization

Prior Authorization means your insurance company wants to give a thumbs-up before you start treatment. Your provider (and sometimes your doctor) has to send paperwork showing why the care is needed, and wait for approval. Without it, insurance might not cover your sessions — even if they normally would. Picture it like getting pre-approved for a loan, but for your health care.

Now, About Paying for It: Deductibles, Co-Insurance, and Co-Pays

Here’s where it gets even more fun (kidding... mostly):

Deductible

Your deductible is the amount you pay out-of-pocket each year before your insurance kicks in. Example: If your deductible is $1,000, you have to pay the first $1,000 of medical expenses yourself.

Co-Insurance

Co-insurance means after you hit your deductible, you share the cost with your insurance. For example: If you have 20% co-insurance, you pay 20% of the bill, and your insurance covers 80%. It’s teamwork... but you’re still paying part of the bill.

Flat Co-Pay

A co-pay is a set dollar amount you pay for a service, no matter what. Like, $25 per visit — whether the session costs $100 or $300. Flat, predictable, and simple.

How can you tell what you need for your insurance?

All insurance companies are different. Its always a good idea to do your own research and call your insurance company directly. Even some auto insurance carriers will apply a deductible to your visits. Health insurance doesn't always cover massage when performed by a massage therapist.

Good questions to ask when you call:

1. Is massage therapy covered on my plan?

2. Is massage therapy covered when performed by a massage therapist?

3. Do I need to meet a deductible?

4. What is my co pay after my deductible is met? (flat co pay or a percentage?)

5. Do I need a referral or prior authorization for care?

6. How many visits are covered on my plan?

   
   

Its important to note that any benefits that your insurance company quotes to you, or to us for that matter, are not a guarantee of payment. Ultimately if they process your bill differently than expected you are still responsible for the cost of your visit.

Bottom line: Insurance loves paperwork. Knowing the difference between these terms makes the process smoother — and helps you avoid surprise bills. If you’re ever unsure, our billing team at Hive Recovery Collective is happy to help you figure it out!

A prenatal massage session being performed, providing relaxation and wellness for the expectant mother, with costs covered by health insurance.