Hi friends,
Over the past 10 months, we have received more than 40 massage denials. This is not random and it is not based on your individual medical need.
The Department of Labor (DOL) has quietly changed how massage requests are handled. This change has not been published or formally announced.
Instead of your Medical Benefits Examiner (MBE) reviewing massage requests and consulting an independent contract physician when needed, nearly all massage requests are now being sent to an internal DOL medical director. When requests go to her, they are almost always denied. Your MBE is then required to enforce that denial.
This has been confirmed by multiple MBEs and by a written response Senator Cantwell’s office received from the Department of Labor.
Right now, approvals are happening only when an MBE does not follow this internal routing practice. It is about a 50/50 split. If your request is sent to the medical director, it will likely be denied. If it is not, it is often still approved.
I strongly recommend reading my letter to Senator Cantwell at the bottom of this page if you want to understand how extreme and unfair this situation has become.
It would be extremely helpful if you could access all your EEOICPA/DOL paperwork within the ECOM portal: https://www.ecomp.dol.gov/#/register
There is a paper/email trail inside this portal that led to your denial and will be extremely helpful to have on hand.
IF YOU RECEIVED A MASSAGE DENIAL, HERE IS EXACTLY WHAT TO DO
Once a massage authorization is denied, it is no longer something we can fix directly. At that point, it becomes a process between you and the Department of Labor.
Please follow these steps carefully.
You can also download a printable PDF checklist of these steps here.
STEP ONE: REQUEST A RECOMMENDED DECISION
You must do this in writing.
You can write something very simple, such as:
“I disagree with the denial of massage therapy benefits for my covered condition(s) and request that a Recommended Decision be issued in this case.”
Include:
• Your signature
• The date
• Your white card number
That’s it. Keep it simple.
STEP TWO: VISIT THE RESOURCE CENTER TO HAVE THEM UPLOAD YOUR REQUEST TO YOUR FILE
Take the following to your Resource Center:
• Your signed and dated written statement
• A copy of your massage denial letter
Ask the Resource Center staff to upload both documents into your electronic case file.
If you need a copy of your denial letter, we likely have it. Just ask us.
If you never received a denial letter:
• Message me and I will give you your massage authorization request number
• Call the DOL at 1-888-805-3401
• Give them your white card number and ask to speak with your MBE
• Tell them you did not receive a denial letter for authorization number ______
• Ask them to mail a copy to you and fax a copy to your provider at:
Tri-Cities Manual Therapy
Fax: 1-509-984-6616
STEP THREE: WAIT FOR THE RECOMMENDED DECISION LETTER
In about one month, you will receive a letter that begins with the words “Recommended Decision.”
This letter will:
• Restate why they denied massage
• Include two waiver forms
Do NOT sign the waivers.
STEP FOUR: OBJECT TO THE RECOMMENDED DECISION
Go back to the Resource Center with:
• A copy of the Recommended Decision letter
In writing, state that you object to the recommended decision to deny massage therapy for your covered condition(s).
Ask the Resource Center to upload this written objection to your file.
STEP FIVE: CALL ME IMMEDIATELY
As soon as you receive the Recommended Decision letter, call me.
At that point, we will begin a formal rebuttal. This includes submitting additional medical and functional evidence showing why massage should never have been denied in the first place.
After 60 days, everything then moves to the Final Adjudication Branch (FAB).
WHAT HAPPENS AT THE FINAL ADJUDICATION BRANCH
The FAB independently reviews your case to make sure it follows EEOICPA law and policy.
They can:
• Approve the benefit
• Deny the benefit
• Send the case back to the district office for more development (called a remand) – this is what happens most of the time
They will also consider:
• Written objections
• Oral hearings
After this review, they issue a final written decision.
WHAT YOU SHOULD BE DOING IN THE MEANTIME
Start documenting the real impact of losing massage care.
• Make a list of symptoms that have returned since massage was denied
• Write down how this is affecting your daily life and function
• Ask your nurses to document, in detail, the decline in your health since massage stopped
• Keep everything tied only to your accepted condition(s)
• Schedule a doctor’s appointment specifically to document this decline
• Keep the visit focused only on your accepted condition(s)
I will help you prepare a letter for your doctor to review and sign if needed.
WHAT I AM DOING ON MY END
I am fighting this at a systemic level.
These denials violate both:
• Federal law under EEOICPA
• The Department of Labor’s own published policy
The law clearly states that treatment can be authorized to relieve symptoms, not just to cure disease.
Last July, I submitted a Freedom of Information Act request to obtain the internal communications that led to these denials. After six months of delays, including the DOL asking me for $5,000 for my request, I was forced to narrow it significantly.
I am now waiting on emails from Dana Honeywell that include the words massage, manual therapy, or pulmonary release. You can read about the obstacles I’ve faced accessing this information here.
Please also read:
• My initial letter to Senator Cantwell
• The Department of Labor’s response to her office
In that response, they admit to breaching procedure and misapplying the law. They also falsely claim these denials only occurred during a single month, which is not true. We received additional denials this week, and MBEs have confirmed the medical director is still intercepting requests.
I have asked Senator Cantwell’s office to clarify:
• Who at the Department authored the response
• Whether denials outside July and August will be reviewed correctly
• When MBEs will receive guidance to stop routing massage requests to the medical director
I am awaiting a response as of 1/23/26.
I also reached out to the Advisory Board on Toxic Substances and Worker Health, which advises the DOL on EEOICPA Part E issues. Unfortunately, that board is currently defunded and unable to assist.
FINAL NOTES
We are still accepting new patients. We are doing everything we can to stay open and keep our incredible therapists employed. If you have United Healthcare Group
Medicare Advantage (PPO) plan, call the number on your card to ask what your out of network benefits are for Massage Therapy (CPT billing code 97124) and Manual Therapy (CPT billing code 97140).
If you know other white card holders who would benefit from massage therapy, please send them our way. We will do everything possible to get them authorized.
We will get through this by staying informed, taking action, and making sure the Department of Labor is held accountable for the healthcare access promised to you by law!