Massage Roots Health Insurance Verification Form (PDF)

Massage Roots Health Insurance Verification Form
To verify your massage therapy benefits, you will need to contact your health insurance
company directly. Locate the customer or member support phone number on the back of
your insurance card. Please print this page and record the information given to you by
your insurance company. If you have benefits, please bring this form with you to your
appointment.
Speak with a representative and ask the following questions:
Do I have Massage Therapy benefits?
Does my plan cover massage when performed by an LMP? (Important!)
Do I need a referral or a prescription to receive massage treatment?
Which types of providers can write the Rx? (P.T., Chiropractor, N.D. etc.)
What is my annual deductible?

How much has been met this year?

Do I need to see an in network provider only to receive benefits?
Is the deductible cost separate for out of network?

How much?

Do I have a co-pay? How much?
Do I have co-insurance?

What is the %?

Is my co-pay/co-insurance rate separate for out of network? How much?
What are my annual limits?
When does my insurance year "roll over" or expire?