Why I Don’t Accept Insurance — And Why That’s Better for You

Suzan D. Walker LMT 104331
Sep 18
3 min read

Woman in a denim shirt writes at a desk with a laptop and packages. Shelves filled with boxes and plants in the background; bright, organized. — Self-Pay and why it's better for your bottom line.

When it comes to your health and wellness, choosing the right massage therapy experience is just as important as choosing a qualified massage therapist. One question I often get is why I don’t accept insurance. While it might seem inconvenient at first, opting for self-pay actually provides significant benefits for both you and me. From personalized care to cost transparency, here’s why self-pay massage therapy in Texas is often the better choice.

The Challenges of Insurance Reimbursement in Texas

Insurance reimbursement for massage therapy in Texas is complex and often discouraging for independent practitioners. Unlike physicians or chiropractors, massage therapists face significant hurdles.

Credentialing Complexity: Independent MTs must undergo a credentialing process with each insurer., which can be time-consuming creating unneeded red tape. In most cases independent massage therapists such as myself are denied due to not working under the scope of a doctor or chiropractor.
Delayed Payments: Insurance companies often have lengthy processing times, leading to cash flow challenges for independent massage businesses.
Coverage Limitations: Not all insurance plans cover massage therapy. For example, Medicare in most cases does not cover massage therapy. In some instances, if a patient is seeing a physical therapist or a pain management doctor, a small percentage of massage services might be covered as part of a larger treatment plan, but this is rare and inconsistent.

In Texas, these issues are compounded by state-specific regulations and a lack of standardized billing codes for massage therapy, making reimbursement even more challenging.

Why Self-Pay Is Better for Your Bottom Line:

Opting for self-pay offers several financial advantages.
Lower Overall Costs: Insurance premiums, deductibles, and co-pays can add up. With self-pay, you pay only for the services you receive, often at a lower rate than your insurance's out-of-pocket costs.
No Surprise Bills: Without insurance involvement, there are no unexpected charges or balance billing.
Transparent Pricing: You know exactly what you'll pay upfront, eliminating the confusion that often accompanies insurance claims.

The Benefits of Self-Pay Therapy

Choosing self-pay therapy offers numerous advantages:

Flexibility: You can schedule sessions at your convenience without waiting for insurance approvals.
Personalized Care: Without insurance constraints, I can tailor treatments to your specific needs.
Privacy: Your health information remains confidential, as there's no need to share it with insurance companies.

A Brief History of Massage Therapy Regulation in Texas

Understanding the regulatory landscape provides context for the challenges faced by massage therapists:

1985: The Texas Department of Health established the Massage Therapy program and Advisory Council.
2015: Senate Bill 202 transferred responsibility for massage therapy regulation to the Texas Department of Licensing and Regulation (TDLR).
2017: TDLR assumed full responsibility for licensing and enforcement in the massage therapy field.

Despite these developments, massage therapy remains underrepresented in insurance networks, partly due to the lack of standardized billing codes and the complexity of the credentialing process.

Comparing Costs: Insurance vs. Self-Pay

Let's consider a hypothetical scenario:

Insurance Plan: You pay a monthly premium of $300, a deductible of $1,000, and a 20% co-pay per session. After meeting your deductible, each session costs you $40, totaling $1,040 annually. Even then, certain massage services might not be covered at all.
Self-Pay: Each session costs $80, totaling $960 annually, with full control over what services you receive. In this example, self-pay is often more cost-effective, and you have the added benefits of flexibility and personalized care.

Protecting Your Health and Your Therapist

While I don't accept insurance, I maintain professional liability insurance to protect both of us. This coverage ensures that in the rare event of an issue, you are safeguarded, and I am protected legally and financially.

Insurance vs. Self-Pay: Quick Comparison

Feature	Insurance	Self-Pay
Cost Transparency	Often unclear until claim is processed	Full cost known upfront
Coverage	Not all plans cover massage therapy; Medicare generally does not; partial coverage possible under PT or pain management	You pay directly for services, no restrictions
Flexibility	Limited by insurance approvals and visit limits	Schedule sessions as needed, frequency controlled by you
Personalized Care	Sometimes limited by insurance requirements	Fully tailored to your individual needs
Billing & Paperwork	Claims, co-pays, deductibles, and potential denied claims	Simple payment at the time of service
Privacy	Health info shared with insurance company	Full privacy; no external reporting needed
Overall Cost	Can be high due to premiums, deductibles, and co-pays	Often lower annual cost when compared to total insurance expenses

Final Thoughts

Choosing self-pay for massage therapy in Texas not only simplifies the process but also enhances the quality of care you receive. It allows for personalized treatments, greater flexibility, and often lower costs. By understanding the challenges of insurance reimbursement, the limitations of coverage, and the benefits of self-pay, you can make an informed decision that aligns with your health and financial goals.