Insurance Terms

Understanding the terms health insurance providers use.

A referral is giving a name and contact information (i.e. specialist). Usually not required.

A prescription/order (Rx) is written by your Primary Care Provider (PCP), it must include diagnosis code(s), number of visits and start date. Massage Therapists cannot diagnose conditions or illnesses. An Rx with diagnosis code(s) is always required by your Massage Therapist to bill your insurance company. 

A pre-authorization may be required for some Health Plans. They must be approved prior to any treatments.

In-Network - Healthcare provider is contracted with your Health Plan.

Out-of-Network - Healthcare provider is not contracted with your Health Plan. Some Health plans have out-of-network benefits.

Secondary insurance - A policy that pays the remainder of your health insurance claim after it has passed through your primary insurance provider. This secondary coverage is a standalone policy and could function effectively as your only health insurance policy if you only had one plan.

Supplementary insurance - Or gap health insurance provides additional coverage after your health insurance has paid out your claim. A supplemental policy is not a standalone insurance plan and only functions when the policy is attached to existing health insurance. This means a supplemental policy only covers what the primary policy covers.

It is your responsibility to call your Health Plan for verification and confirmation of your massage therapy benefits.