By Sue Shekut, Owner, Working Well Massage, Licensed Massage Therapist, Certified Wellness Coach, ACSM Personal Trainer
Massage therapists and and chiropractors have had a symbiotic relationship over the years. Chiropractors hire massage therapists and massage therapists often refer clients to chiropractors and/or rent space from chiropractors. I used to teach the Business class at one of the local massage schools, and, as a business owner myself, I have to keep up on laws and regulations regarding massage…and chiropractic. Unfortunately a recent law has put the chiropractic profession a bit at odds with massage therapists. To enlighten clients and other massage therapists, I am going to break down some of the current laws regulating massage and chiropractic are in Illinois.
The Law Regulating Massage Therapists in Illinois
The State of Illinois began requiring massage therapists to obtain a state License for Massage in January, 2005. This law requires massage therapists to complete schooling of at least 500 hours, take and pass the National Certification Exam and pay a fee every two years. In Illinois, Massage Therapist’s are also required to take 24 hours of continuing education credits every two years. This licensing act was an attempt to further legitimize massage therapy (and make it clear massage is not prostitution) and give massage therapists a uniform standard of education and ethics to follow. Prior to this law, each municipality regulated massage according to their own guidelines. Some cities had stringent regulations, others had none. The state law helped eliminate this confusing patchwork of regulations and put massage therapy under one set of rules, the Massage Licensing Act.
The Massage Licensing Act requires licensees to be fingerprinted as part of the license application process. This is required to help protect the public from sexual predators and other people with a history of sexual violations. The law also requires massage therapists to have taken and passed courses including kineseology and anatomy and physiology. This means that licensed massage therapists know how your muscles attach, work and can be injured–and how to reduce muscle tension and “knots” in your muscle tissue.
The Law Regulating Use of Unlicensed Persons to Perform Massage In Chiropractic Offices
However, the State of Illinois then passed an act, 22S ILCS 60/Medical Practice effective January, 2010, that allows Chiropractors to hire unlicensed, and potentially untrained staff to give clients “therapeutic” massages at the Chiropractor’s office. Chiropractors may have lobbied for this bill saying that they did not want to have to wait for students to pass their licensing exam before they could work for chiropractors. However, there is no shortage of Licensed Massage Therapists in Illinois (According to the ABMP, there are currently about 8,000 Licensed Massage Therapists in Illinois). And chiropractors can directly bill insurance companies for massage services, while independent massage therapists cannot for most insurance companies in Illinois. Ironically, according to a representative I spoke to at Blue Cross Blue Shield, even with a high-end Blue Cross insurance plan, only chiropractors are allowed to perform the massage, not massage therapists, in order for the insurance company to reimburse for the massage.
Unfortunately, this paves the way for chiropractors to now hire unlicensed, potentially unqualified people to give clients their massages and then in some cases, the chiropractor may bill the insurance company for those massages even if the chiropractor does not perform the massages. Thus untrained employees can be allowed to provide direct patient care to patients with medical conditions. Untrained people can injure you while doing massage work because they haven’t had the 500-hour massage school training (which includes not only training on proper massage techniques, but also anatomy, kinesiology and physiology. And ask a massage therapist: most chiropractors do not stand over massage therapists as they work, monitoring their massage performance–chiropractors are usually working on other patients. In some offices, chiropractors work in one room while the massage therapist works behind closed doors in another room.
License Massage Therapists may lose work to unlicensed people because the chiropractor can hire someone else to do the same work for less pay. In addition, Public Act 096-0618, does not afford the public protections from sexual predators or require unlicensed massage therapists to be finger printed or background checked! It is not clear how this new law protects the public or can be said to be for the public good.
Note: Reimbursement requirements depend on your particular insurance plan.
As a client, what can you do to protect yourself and make sure your massage therapist is qualified and licensed?
1. Check the State of Illinois Division of Professional Regulation website to look up your Massage Therapist by name and see if he or she has a valid state Massage Therapist license here.
2. If you receive massage from someone at a chiropractor’s office, ask the chiropractor if the massage therapist is licensed. If not, ask for a massage therapist that is licensed by the state and has completed all required training and testing.
3. If your insurance company has been paying a portion or all of your massage bills at the chiropractor, check with the insurance company to find out the exact requirements for reimbursement. Does your insurance company require the chiropractor to personally perform your massage or can they have someone in their office perform the actual massage for reimbursement?
If the insurance company requires the chiropractor to perform the massage, and your chiropractor charged your insurance company for performing massages then he/she delegated the massage to a staff member that is not a Licensed Chiropractor, your chiropractor could run into trouble with the insurance company. If the insurance company ever found out, you may also be in trouble too. You may have to pay back the insurance company for your massages and you may also be accused of committing insurance fraud. But, if it’s a great deal for you and the chiropractor to have the insurance company pay for your massage, who would ever tell the insurance company? Well, a disgruntled employee of the chiropractor’s office for one. Or a spouse divorcing one of the chiropractor’s patients could be a whistle blower. Anyone with a bone to pick with the chiropractor. (Bad pun intended.) Ask yourself if saving a few dollars is worth the legal risk.
4. Note that using a Flexible Spending Account or Health Savings Account (HSA) for to pay a massage therapist directly for your massages IS legal IF the massage is considered therapeutic. For example, if you have been diagnosed by a doctor or chiropractor with plantar facitis or a low back or cervical disorder that requires massage, that would be a therapeutic massage. Or, if you have fibromyalgia or a repetitive injury such as a thoracic outlet syndrome, massage to help with these conditions would be considered therapeutic. Check with your Flex Spending or HSA account administrator for details of your specific plan. To be an expense for medical care, the expense has to be primarily for the prevention or alleviation of a physical or mental defect or illness. Check the U.S. Government’s rules for “qualifying medical expenses” here.
For example, a Cigna plan allows you to use a FSA or HSA funds to pay for massages if they are used to treat a physical defect or illness. Cigna Plan - Fees paid for massages are not reimbursable unless to treat a physical defect or illness. Physician’s diagnosis letter required.”
I don’t want to scare anyone out of getting a massage at your chiropractor by any means! Most chiropractors are law abiding and follow insurance company guidelines. I work closely with several chiropractors and I refer clients to them often. But knowing the law and abiding by it may save you from problems and legal issues down the road.