Sooo… There is a very touchy subject we all have as a nation before us. Politricks is not a subject that I normally bring up in the office. It usually reverses that feeling of relaxation, so it’s a general no-no until it effects the very field I work in. I read an excellent article earlier this week and have been letting it tumble around in my little head about how I would like to share this with you. My goal today is to explain to you my own concerns of Massage Therapy “being included” in a “traditional” health care setting. I would LOVE to hear some feedback on this! I’ll also include a link to this article later on below.
That being said, I’ll make my main point first.
True Therapeutic Massage (Medical/Clinical Massage) always approaches the client as a whole being. Not as a symptom, not as a list of complaints that need to be subdued or have pills thrown at and certainly not as a small number of visits allowed in which you can only work in certain areas. When using Medical Massage, the client is included in the whole process, is shown what is causing injury/strain and given the tools to change themselves. It is very much up to the client how much they want to recover and get back to functional living again.
When I have someone come into my office, we go over many aspects of the client’s activities, typical routine, range of motion, injuries and physical restrictions. Why? Because there you will typically find what causes many of the postural issues that cause common strains, aches & pains within the client. As we work together more, it’s normal to find that session goals change, new information relating to past injuries may surface which gains a greater insight into present dis-function. There is always a goal of rehabilitation and there is always a wide scope lens being used by the Therapist (me!) to get there. Your pulled neck could very well be from the fact that you carry your hip higher on the left than the right. There is NO way to treat one area of the body without treating the rest of it! So we start treating and releasing it, and the client is given stretches and strengthening tips to help resolve this issue. For most folks, this is a normal experience with their Massage Therapist.
IF Massage Therapy were to be included in a “typical” health care system, how might this change? As is stands, the best experience I’ve gotten of this possibility thus far is when I’m working with No Fault Insurance claims. Let me share with you some of my struggles.
This situation is always due to some type of automobile accident and the client receives a Prescription for massage. Each Rx is usually for 4-8 sessions, depending on the severity of the accident and the length of time for each session. As it stands, I have to advise the client to have the Rx written out for 1/2 hour sessions, as the insurance companies will not cover a full hour of massage. They will only pay for 45 minutes within a 48 hour period. This is part of our NY No fault Regulation (68) Law and it hasn’t changed since 2002. Personally, I prefer to see clients at least 2x weekly when recovering from accidents. Thus a Rx for eight 1/2 hour massages is a great solution. So far, not a big problem.
Insurance companies dictate to me what they will pay me, they do NOT ask what I charge. In fact, they don’t care. I was told at one point, that if I had a problem with the way things were to take it up with my local legislature. WOW, that blew me away! The fact that I would have to talk to my local congressman about getting paid fairly by an insurance company (i.e. forcing them with some kind of law change!!) and not talk directly to someone within the company itself should speak volumes to more people than just me! I’m not looking to make a quick buck here, in fact I get paid less through No Fault Insurance than what my normal fees are in my office! Rates typically change because the cost of operation goes up. Insurance companies know that reasoning very well as they use it all the time. However, they do not travel down a two way street and don’t use that same logic when it comes to having to pay an LMT for their work. The cost of operation has certainly changed since 2002 for the typical Massage Therapist.
Now we come to my biggest issue. While I am working with a client with such a Rx, I am not allowed to work on any other place of the body except for those given a code for in the Rx itself. If your neck was injured, and I know that you would have a much better release if I were to able to work within the pelvis first, I wouldn’t be able to. It’s not part of the neck, Therefore it’s not included in the “approved” areas that need massage. This kind of rule is understandable to an extent, however it hinders true healing in the long run. Many MD’s don’t look at the muscular body the same way a Massage Therapist does, Insurance companies definitely do not at all. Why am I wanting to focus on the opposite side of the body that received impact? Because it contracted and reacted more to the physical trauma of the accident. The client may feel sensitivity/pain in the neck, however it could be from the pelvis that was thrown to one side introducing compensation in the center of balance within the client. It could be a combination of the physical trauma of the accident and what the client does for a living. I have to be able to treat the whole body to get the best results, not just the areas the Insurance company will “cover”. Try explaining that to an Insurance Rep, they don’t care. No massaging any other areas during the session, they are not budging.
If Massage Therapy were to be included in a health care system that is already treating it like this, what would the ultimate impact be? Would there ever be an understanding that the Medical Massage Therapist has very direct and specific techniques to help the elimination of pain and that no matter what they need the space to work and effect the whole body of the client? Or would we continue to see a power struggle between Insurance companies, the regulation makers and the Therapist? I’m worried that the benefits of massage, the client becoming aware of the whole self and treatment of the whole person would be lost. We might loose the ability (or even worse, the right!!) to heal ourselves altogether. That’s the scenario I want to avoid completely. If that means that I don’t work within a system that doesn’t understand what it is that I do in the first place, then I know that my clients and I will be all the better for it.
What do you think? I want to know your concerns and how this might affect you and your families. We’re all wanting the same goal, to have a system in which the client IS the center. Where we the practitioners work TOGETHER to benefit the client and not coat pockets. Can it be done?
By Ralph Stephens, BS, LMT, NCTMB