There’s no getting around it, healthcare is expensive, for both premium and out-of-pocket costs. Understandably, then, I’ve been asked if I take insurance often enough that I felt it deserved a full response here.

First, I do not accept private or public health insurance. There are many reasons, but the upshot is that billing health insurance directly means more time trying to get paid, and less time getting better at serving you.

That being said, your health insurance company may be willing to reimburse you if you pay out-of-pocket. HMOs often have massage therapists in their network, and thus won’t reimburse for anyone else. Companies such as Blue Cross Blue Shield may have less restrictive policies. Either way, call your health insurance company and ask if you can submit an itemized receipt for reimbursement from an out-of-network massage therapist.

If you aren’t able to submit receipts to your insurance company, there are a number of pre-tax options available to you.

If you are participating in your employer’s Flexible Spending Arrangment you can request a reimbursement. What’s an FSA, you ask? Your employer can allow you to set aside up to $2550 per year, pre-tax, for out-of-pocket medical costs. These plans are usually managed by a Thrid Party Adminstrator (TPA) such as TASC or eFlex, and often come with debit cards. If your employer offers an FSA, but you’re not currently participating, you’re going to have to wait until the next Open Enrollment. If your plan renews in Janurary, Open Enrollment is usually in October or November.

You can be reimbursed for massage therapy expenses if you submit an itemized receipt, along with a Letter of Medical Necessity from your physician. Some plans will allow you to swipe your debit card at the time of service, and some don’t, so check with your plan administrator. The receipts generated by my credit card reader and my booking software do not qualify, but I’m happy furnish one on request.

If you have a Qualifying High Deductible Health Plan, you also qualify for a Health Savings Account (HSA). The eligibility rules for HSA reimbursement are the same as for an FSA, but you can definitely use your debit card. HSAs are bank accounts, and the plan administrator does not have a fiduciary responsibility¬† like they do with an FSA. Rather than submitting documentation, you’re responsible for keeping it with your tax records for the year.

Finally, you may be able to include massage therapy costs on your tax return as a qualified medical expense. You must file an itemized return, and if you cannot receive reimbursement from a pre-tax account. See IRS Publication 502 for details. Again, you must have a letter of medical necessity and itemized receipts.

So what, exactly, needs to be in that letter? Your doctor needs to state that you are being treated for an acute condition; general wellness care is not eligible. A letter of medical necessity is different from a prescription. Your doctor does not need to include a diagnosis or billing code, or specify frequency or duration of treatment.

Your state determines who qualifies as a referring physician. In Wisconsin, this includes Medical Doctors, Doctors of Physical Therapy, and Chiropractors. This does not include Naturopatic Doctors, unfortunately, so keep that in mind.

I used to work for a TPA, so I’m on solid footing here, but please, PLEASE, check with your insurance company or plan administrator before deciding on a course of action. I hope this helps!