Insurance
Does Insurance Cover Acupuncture?
Today, more and more insurance companies are offering full or partial coverage for acupuncture treatment. However, just because your insurance company "covers acupuncture" that does not necessarily mean they will pay for your acupuncture treatment. To truly understand your insurance coverage, you need to start by asking the right questions.
Firstly, it's important to understand that insurance companies offer many different types of policies with different benefits. In other words, if you have a friend with the same health insurance company as you, and that friend has acupuncture coverage, then you can logically infer absolutely nothing about whether you have acupuncture coverage. This is because your friend's policy most likely offers different benefits than your policy.
Similarly, if you call an acupuncture clinic inquiring about treatment and tell the acupuncturist the name of your insurance company, that acupuncturist cannot possibly know for certain whether you have acupuncture coverage. Determining that information would require investigating your specific policy, not simply getting the name of your insurance company. Therefore, we need to start by asking the right questions about your specific health insurance policy.
Start by calling your insurance company. There is almost always a customer service phone number on the back (or sometimes front) of your insurance card. There may be a maze of telephone prompts to navigate, but eventually you should be speaking directly with a customer service representative to find out about your policy benefits. The first question to ask is whether acupuncture treatment is covered on your policy. The answer should be either yes or no. If the answer is no, your insurance company will not pay for your acupuncture treatment ... period. If the answer is yes, your insurance company may pay for your acupuncture treatment, but first we need to learn more about the details of your policy.
If you have acupuncture coverage, you should ask if there are coverage limits to the number of treatments (or dollar amount paid for treatment) and how much of these limits have already been used. If the limits have been met or exceeded, the benefit has been exhausted and you should not expect payment from your insurance company. Next, it is important to ask if there is a deductible amount which applies to acupuncture treatment. If a deductible applies, you should ask how much of that 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.
Now let's find out which providers are covered. It is most likely the case that treatment administered by one acupuncturist is covered while treatment administered by another is not. Start by asking about the difference in coverage between an in-network provider and an out-of-network provider. 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 from an MD is required for your policy. In Florida, a MD is allowed to provide acupuncture treatment with no formal oriental medical training. Lastly, ask if there are specific acupuncture diagnosis requirements. If you've met all of the criteria above, you still should understand that 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, as some do. At the end of your conversation, remember to ask the customer service representative for an ID number for the phone conversation that you're having, and keep that ID number saved somewhere. In this way, if the claim is processed in a manner inconsistent with what you've been told, you can contact the insurance company and refer specifically to the conversation in which you were given different information. For the phone call ID you may be given a very long number or simply the representative's name and the current date, but either way it is worth saving until the claim has been processed in a manner consistent with your expectations.
Lastly, there is a common misconception that healthcare providers have a "direct line" to the insurance company to determine benefits and eligibility, but believe it or not, providers often have to jump through the same hoops as do members, if not more. In fact, the insurance company will usually offer better customer service to its members than to the providers. After all, insurance companies know that if members are unhappy, those members can switch to (and subsequently pay their premiums to) another health insurance company. Health providers, on the other hand don't pay premiums to health insurance companies, and as a result have less recourse.
Before finishing, I'd like to offer one final piece of advice. Don't be intimidated about calling your insurance company. You're the customer ... and you pay a lot of money for your health insurance. Get involved and become informed. You should understand your health insurance policy better than anyone else. Let your insurance company know if you're not satisfied with your service or your policy. By taking responsibility, we can help improve the system for everyone.
We are starting a sign-up sheet for people who think they have qualifying acupuncture benefits on their insurance policy and would like to have their insurance billed. We need a minimum number of people to proceed with insurance billing. If you would like to be on this list send an email to floridaacupuncture@yahoo.com and type "Insurance" with your contact
information. Thank you.
