Does Blue Cross Blue Shield Cover Massage Therapy in Oregon? Regence Plans Explained
Updated: Oct 3
Some Blue Cross Blue Shield plans in Oregon cover massage therapy, and some don't. The answer depends on your specific plan. In Oregon, Blue Cross Blue Shield plans come from Regence BlueCross BlueShield of Oregon. When a Regence plan does cover massage, the coverage often comes with conditions, such as a medical reason for the visit or a yearly visit limit. At Blue Renew Massage Therapy in East Portland, I'm an in-network provider with Regence. I check each insurance client's Blue Cross Blue Shield coverage before anything is booked, and I bill the insurance company directly.
Why does massage coverage depend on your plan?
Blue Cross Blue Shield is a national group of 33 independent, locally operated companies, and each company sells its own plans. In Oregon, that company is Regence BlueCross BlueShield of Oregon.
Regence offers the plans, and your employer chooses which benefits go into the plan it offers you. If you bought your plan yourself, the plan you picked sets your benefits. That means two people with Regence cards can have different massage benefits, or one can have massage coverage and the other none.
Where does massage show up in a Regence plan?
The examples in this article come from Regence's Oregon plans for people who buy their own coverage. If you get Regence through work, your plan may word things differently.
In these plans, massage doesn't have its own line. It's listed under rehabilitative services, along with physical, occupational, and speech therapy.
Regence's Oregon individual plan policy defines rehabilitative services as physical, occupational, and speech therapy, "including services such as massage when provided as a therapeutic intervention." In plain terms, the plan covers massage when it's part of treating an illness or injury. An employer's plan may list massage under a different benefit, such as alternative care.
Because massage may be listed under another benefit, searching your plan for the word "massage" alone might not find it. Search for these terms too:
Rehabilitative services
Physical therapy
Physical medicine
Alternative care
Massage or massage therapy
The easiest document to start with is your Summary of Benefits and Coverage. Every insurance company and job-based health plan has to give you this short, plain-language summary of what your plan covers. You can find it, along with your full plan documents, on regence.com or by calling member services.
Do you need a referral or prescription for massage with Regence?
You don't need a referral in the Regence plans in these examples, but prescription rules for massage can differ by Regence plan.
A referral and a prescription are two different things. A referral is your doctor's approval to see another provider, and these plans don't require one for any of their benefits. A prescription is a written order for massage from your doctor. Regence has noted in an update for providers that not all of its plans require a prescription for massage therapy. When I check your coverage, I find out whether your plan needs a referral, and I tell you before anything is booked.
Does Regence limit massage visits or require prior authorization?
Many plans limit how many therapy visits you can use each year, and some plans require approval before your visits are covered. Your plan documents list both.
In these Regence plans, the yearly visit limit is shared across all the therapies under rehabilitative services. That means every physical therapy visit counts toward the same limit as your massage visits. If you've already had physical therapy this year, you may have fewer massage visits left than you expect. The number of visits differs from plan to plan. I look up your plan's limit when I check your coverage, or you can find it in your plan documents.
Some plans also require prior authorization, which is approval from the insurance company before your visits are covered. In these plans, the provider who gives your care sends in the request.
Does the massage therapist need to be licensed or in network?
Yes, the therapist needs to be licensed. Network status matters too, because it can change how much your plan pays. These plans only cover care from a provider who is licensed to give that type of care.
In Oregon, that means a licensed massage therapist (LMT) licensed by the Oregon Board of Massage Therapists. You can look up any massage therapist's license on the Board's website.
Your plan's network is the group of providers your insurance company has a contract with. A provider outside that group is out of network, and your plan may cover less of the cost when you see them. Your plan documents explain how your plan handles out-of-network care.
Does insurance cover a relaxation massage?
Usually not. In these Regence plans, massage is covered when it's part of treating an illness or injury. A massage just to unwind usually isn't covered.
Regence's policy says covered services must be medically necessary for the treatment of an illness or injury. That's the insurance company's rule. If you want a massage to relax, you can still book one with me and pay the cash rate.
What will you pay for massage with Blue Cross Blue Shield?
Your cost depends on your plan's deductible, copay, and coinsurance. Your deductible is the amount you pay for covered care before your plan starts to pay. A copay is a fixed amount you pay for each covered visit. Coinsurance is a set percentage of each covered visit's cost that you pay.
Your plan's rules decide which of these costs apply to massage visits. When I check your coverage, I tell you what you'll owe, so you don't get a surprise bill.
How to check your Regence massage coverage
You can check your coverage yourself in a few steps, or ask a massage therapist who bills insurance to check it for you.
Sign in to your Regence account. Go to regence.com or open the Regence mobile app to look through your benefits and coverage. Find your Summary of Benefits and Coverage and your full plan documents on regence.com, then search them for "rehabilitative services," "physical therapy," "physical medicine," "alternative care," and "massage."
Call member services. Use the phone number on your Regence ID card.
Ask specific questions. Write down the answers and the date of the call.
Does my plan cover massage therapy, and under which benefit?
Do I need a referral or prescription?
How many therapy visits do I get each year, and are they shared with physical therapy?
Does massage need prior authorization?
Do I need to see an in-network provider?
What's my deductible, and do I pay a copay or coinsurance for these visits?
Or have your massage therapist check. If you'd rather skip the phone call, text me the details on your insurance card and I'll check your coverage for you.
Some people in Oregon have a Blue Cross Blue Shield plan from another state, for example through an employer based elsewhere. You can still get care in Oregon through the BlueCard program, which lets members of one Blue Cross Blue Shield company get care in another company's area. Your own plan's rules still decide what's covered, so check your plan the same way.
Using your Blue Cross Blue Shield benefit at Blue Renew
I'm Corey Blue, LMT #28443, and I run Blue Renew out of a studio at 2442 SE 101st Ave, Suite 308, in East Portland. I'm in network with Regence BlueCross BlueShield of Oregon, and I accept insurance from other Blue Cross Blue Shield plans too. I also accept Kaiser Permanente, Providence, and American Specialty Health (ASH) network plans.
Before anything is booked, I verify your coverage with your insurance company. After your session, I bill the insurance company directly, so you never file a claim yourself. If your plan doesn't cover massage, or you'd rather not wait for verification, you can pay cash: $100 for 60 minutes or $140 for 90 minutes.
To find out whether your Blue Cross Blue Shield plan covers massage, call or text me at 503.912.4130 with the details on your insurance card, or reach me through my contact page. I'll check your coverage and tell you what you'll owe before anything is booked.
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