Coverage and Limitations of Paramedical Practitioners

May 12, 2015

Is there anything better than a nice relaxing massage at a lovely spa after a stressful day of work? Perhaps not as this type of massage may not be covered by your benefits plan.

Most paramedical practitioners have a governing body that accredits their particular profession. In order for a massage therapy visit to be covered by your benefits plan, the therapist is required to be a registered massage therapist (RMT) who treat patients that are suffering from joint or muscle pain.

Although the top three paramedical practitioners most utilized by employees are physiotherapists, chiropractors and massage therapists, the list of practitioners may also include the following: podiatrist, naturopathic doctor, acupuncturist, psychologist, speech therapist, ergotherapist, audiologist, homeopathic doctor, social worker, and athletic therapist.

As you can see, there are many other types of practitioners, each catering to a specific health care need. Generally speaking, there are variations of coverage between carriers, as each insurance company determines their own standardly covered practitioners. Employers can also opt for a customized list of practitioners to be added to their benefit plans.

Another important item to note is that coverage for these practitioners is limited in two ways. First, there is a dollar amount maximum per visit, such as a reasonable and customary amount that is set by the insurance carrier. If your practitioner charges more the reasonable amount, you will be required to pay the difference. Second, there is an overall maximum amount per year for each practitioner. For instance, many benefit plans have a $500 per year maximum for each practitioner. Once you’ve received your annual maximum, you will not be reimbursed for additional visits until the next benefit year.

In order to get the most value from your benefit plan, it is important to understand the schedule of coverage, the practitioners’ fees and their credentials. By getting all the facts ahead of time, you can avoid any out of pocket surprises after that relaxing spa massage!

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