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Plan limits coverage for massage therapy

The number of massage therapists qualified to bill the state Public Employees Insurance Agency soon will be reduced by nearly two-thirds.  

Recent adjustments to PEIA health plans will limit the number of massage therapists public employees will be able to visit and submit claims for.

Under the revised plan, which goes into effect next summer, state massage therapists billing PEIA must have current national certification, carry $2 million in malpractice insurance and abide by treatment guidelines to be published by the agency with input from the American Massage Therapy Association.

Ted Cheatham, executive director of PEIA, said last week the new regulations would cut the pool of therapists qualified to bill the agency from about 1,100 to 378.

The changes were part of cost-saving measures taken by the agency. Its finance board last week cut health care benefits for the next fiscal year by $18.4 million. The changes include new or increased co-payments for some treatments.

Participants will pay a new, $10 co-pay for massage therapy services next year, in addition to their deductible and co-insurance payments.

The agency paid $762,000 in claims for massage therapy during the 2011 fiscal year.

Derenda Weekley, president of the West Virginia chapter of the American Massage Therapists Association, says the new regulations will be good for massage therapy in this state.

Weekley, who works as a massage therapist in Huntington, said years ago any massage therapist who filled out the proper paperwork could become a PEIA provider.

"Entry-level therapists could become PEIA providers. I felt that if I was going to bill insurance, I would want someone who's qualified," she said.

"I'm sure there's going to be some therapists that are upset, but in the long run I think it's going to be good for PEIA clients and massage therapists."

Things certainly could have been worse. The PEIA board originally considered cutting massage therapy coverage altogether. Members of the public and state massage industry protested the move at public hearings held last month.

"It would have hurt a lot of therapists; it would have put them out of jobs," Weekley said.

The board decided to restore massage therapy coverage but add the $10 co-pay.

Cheatham said he met with members of the West Virginia chapter of the American Massage Therapists Association following the hearings to hammer out new regulations.

"We took their recommendations. We thought they were fair and they were balanced," he said. "That shows their ability to reach out for continuing education. I thought that was forthright."

Therapists also must receive about 24 hours of continuing education every two years to maintain their national certification, Weekley said. Those include classes on ethics, appropriate behavior, appropriate dress and Health Insurance Portability and Accountability Act provisions, in addition to massage therapy technique.

While most people think of upscale spas and luxurious resorts when they hear the word "massage," Weekley said the therapy is a clinical procedure that can be quite uncomfortable for the recipient.

The treatment is sometimes used as an alternative to physical therapy, and patients need a doctor's prescription to start massage therapy coverage, Cheatham said.

"A lot of times, when you say massage, they think of this hour-long, feel-good deal," Weekley said. "It could be the most painful thing you've ever experienced."

She said massage therapy is used to release scar tissue and "trigger points," painfully irritable spots on muscles also called "muscle knots." Sessions can be as quick as 10 minutes.

The therapy also is used to lower blood pressure and insulin levels and boost a patient's immune system.

"I believe in trying every means possible that alleviates something before having to have surgery or take pills," Weekley said.

Starting next year, PEIA participants will not have coverage for acupuncture services.

"This is going to affect a lot of the teachers," said Michelle DeStefano, treasurer of the West Virginia Board of Acupuncture.

DeStefano, a Shepherdstown acupuncturist, said the coverage changes probably won't hurt her business but will affect several of her patients. She currently treats a half-dozen teachers and a few other public employees.

Patients pay $120 for their first visit and $75 for each subsequent one. The treatments last from 45 minutes to an hour, and DeStefano recommends beginning patients receive treatments once a week.

"As they get better, it might be six to eight visits, then the treatments might be once a month or once every three months," she said.

She never billed PEIA, but patients would pay a fee and then collect reimbursements from the insurance agency. PEIA paid $70,180 in acupuncture claims in 2011's fiscal year.

"Now they're not going to be able to come as often," she said. "This helps keep their stress levels down. It is widely known that stress is a big factor in exacerbating illnesses, or even creating illness."

She also treats patients with hormonal problems, neck pain, certain kinds of back pain and carpal tunnel.

"We're getting really good results with carpal tunnel," she said.

Linda Lyter, executive director of the West Virginia Massage Therapy Licensure Board, said there are about 1,200 licensed massage therapists in the state. About 200 more are licensed to work in the state but do not live here.

Lyter also is executive director of the West Virginia Board of Acupuncture. She said the state has 42 licensed acupuncturists, with half of those living in the state.

Many therapists and acupuncturists maintain licenses in multiple states, she said.

Contact writer Zack Harold at 304-348-7939 or zack.harold@

dailymail.com. Follow him at www.twitter.com/ZackHarold.


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