Insurance Coverage for Acupuncture
Yes, we accept insurance. Many insurance plans offer full or partial coverage for acupuncture treatment. In order to have a complete understanding of your specific insurance plan you will need to contact your insurance provider and ask the questions below:
Start by calling your insurance company. There is usually a customer service number on the back of your insurance card. There may be a maze of telephone prompts to navigate, but eventually you will want to speak directly with a customer service representative to ask about your policy benefits:
1.) Is Acupuncture treatment covered on your policy? The answer will be either Yes or No. If the answer is No, your insurance company will not pay for acupuncture treatment. If the answer is Yes, your insurance company may pay for your acupuncture treatment, but additional details are needed:
If the answer was “Yes”:
2.) What is your copay amount for acupuncture? This copay may be a fixed dollar amount or a percentage.
3.) Are there coverage limits on the number of treatments? Are there dollar amount limits? If so, how much of the limit has already been used. If the limit has been met or exceeded, the benefit has been exhausted and you should not expect any payment from your insurance company.
4.) Is there is a deductible amount which applies to acupuncture treatment? If a deductible applies, you should ask how much of the out-of-network deductible has been met and what the deductible period is. You should expect to pay-out-of-pocket until the deductible has been met for the current deductible period.
5.) Are you covered for out-of-network providers? Having out-of-network benefits will ensure that you get the best coverage. Our clinic is out-of-network for all insurance providers. It is also wise to ask whether your policy allows acupuncture to be administered by a licensed acupuncturist or if it stipulates that treatment may only be administered by an MD. In addition, you should ask if a referral or pre-authorization is required for your policy.
6.) Lastly, are there any specific acupuncture diagnosis requirements? Even if you’ve met all of the criteria above, an insurance company will pay for acupuncture only when treatment is considered medically necessary and acupuncture is an appropriate treatment for the patient’s condition. For example, most insurance companies will consider acupuncture appropriate for treating low back pain, but very few insurance companies will consider acupuncture appropriate for treating Rocky Mountain Spotted Fever, as there is little evidence that acupuncture is helpful in treating this condition. Not all insurance companies will provide you with this type of information, but it’s worth asking.
Very simply, you will pay whatever your insurance plan does not pay to cover our office rates. Our office rates are $125 for Initial visit and $105 for follow-up visits. For example, if you your plan pays $50 per visit then you would pay our office rates minus $50.
Additional Notes: It’s important to know that insurance companies offer many different policies with a variety of different benefits. Two plans from the same health insurance company will often have very different coverage, even if they look the same on the surface. Similarly, knowing the name of your insurance company alone does not help specify whether you have acupuncture coverage. Determining that information would require asking the questions above to investigate your specific policy.
Why is our practice out-of-network? We were previously in-network for many years with major insurance providers. Unfortunately, the in-network model pushes practitioners towards providing a lower quality of care for patients. The in-network model is built around Western doctors who typically have 8-15 minute appointments and therefore run a high volume practice in order to make the numbers work. We choose to have a practice that is quite the opposite of the Western system where there is ample time for discussion, treatment, and follow-up.
The bottom line is this: As an in-network provider we were not able to provide the level of care we wanted for our patients. After weighing the options and we have chosen to stay out-of-network so our patients can receive a very high level of personalized care, giving them the time and attention they deserve.
Before finishing, I’d like to offer one final piece of advice. Don’t be intimidated to call your insurance company. You’re the customer and you likely pay a lot of money for your health insurance. Get involved and become informed so you understand your health insurance policy better than anyone else. If you are not satisfied with your insurance plan’s service or policy, let them know and push for changes.
Once you have called your insurance provider, get started with an appointment today: