Acupuncture and Insurance
Acupuncture and Insurance
by Stephanie Huth-lipnicki, LAc
I wanted to help de-mystify Acupuncture and Insurance, because hey, it can be confusing. There are many companies who do cover Acupuncture, and there are many who still do not.
We will always check to see if Acupuncture is a covered benefit through your policy. To do this we typically make a copy of your insurance card as well as your date of birth.
So, let me try and help to make things clear with how insurance and Acupuncture coverage works.
IS ACUPUNCTURE A COVERED BENEFIT: The ideal answer we love to hear is yes it is a covered benefit. Sometimes, the answers we hear are things like, yes, but only for anesthesia – definitely not the favored answer. We have yet to meet the physician who allows us to come into their surgery to perform Acupuncture for the purpose of anesthesia. If the answer is no, don’t feel jilted. Only 1% of insurance companies nationwide currently cover Acupuncture at all.
OUT OF NETWORK vs IN NETWORK BENEFITS: Right now, at our center, we are “Out of Network .” So what does this mean? Your insurance may have coverage for “In network” and “Out of Network.” If you have Acupuncture benefits, and they cover practitioners that are “Out of Network” than we can bill your insurance company for Acupuncture treatments.
DEDUCTIBLES: The next concern, when dealing with insurance is whether or not you have an “Out of Network” deductible. What does this mean? I’ll give an example. If you have a $200 deductible, your first few treatments will still get billed to your insurance company. So the first few treatments you will pay out of pocket, then once your deductible has been met, your insurance will either pay for a portion of your treatments or all of your treatments. If your deductible is $1000, this isn’t the best answer. You will need to meet the $1000 deductible before your insurance will pay for any of your visits. Your deductible is per calendar year. So if it is January, your deductible is usually reset, and will need to be met again.
VISITS PER YEAR: Once your deductible has been met, the next area to focus on is how many visits per year or per diagnosis? To explain this a little better, what this means refers to is the number of visits per year your insurance will cover. So if your insurance only covers 12 visits per calendar year, and you have a chronic condition, this is not such a great answer. This means that within a few months, you will probably use all of your allowed treatments, and then the remaining treatments will be out of pocket for you. Now of course, our favorite answer for the patient is, an unlimited number of visits per year. This gives the patient more control over their health because the patient can decide when they need to come and how often and work this out with their health care provider.
WHAT PERCENTAGE OF TREATMENT IS COVERED: Insurance companies cover treatments at various percentages. These amounts can vary for in and out of network practitioners. So, once your deductible has been met, if your insurance covers at 80%, there may be a small portion of the treatment that is considered to be the patient’s responsibility (i.e. the 20% not covered by the insurance company).
So, let me try and sum up, and give a couple of complete scenarios of how this can work.
Alec Baldwin’s* insurance company covers Acupuncture as a benefit. His deductible is $350, but he has a limit of 24 visits per calendar year, and they are 100% covered. The way we bill the insurance company, the deductible will be met within his first three visits, his out of pocket cost for the first three visits will be $350. Then for the rest of the year, since Mr. Baldwin’s deductible has been met, the remaining 21 visits for the year are covered. So the cost for his Acupuncture treatments for the year would be in total $350 for 24 Acupuncture treatments (in other words, less than $15 a visit)! He will not have to pay until the following calendar year, once the deductible resets in January.
Tina Fey’s* insurance company has a $100 deductible, and unlimited visits per calendar year at 80% coverage. So Ms. Fey comes in for her first visit, receives Acupuncture, the initial amount we bill will be applied to her deductible, they may actually reimburse for part of that visit. So, Ms. Fey will pay $100 and her insurance will pay $20 toward the initial visit. So after paying the $100 portion toward her deductible, all her remaining visits are covered so as long as the insurance company pays at 80% of what we bill, there will be no remaining fees to the patient. So if Ms. Fey comes to our center 1x a week, 2x a week or even 3x a week after her deductible has been met, she will not have to pay for the remaining treatments. Her next amount to be paid will be the following calendar year, once her deductible resets.
Again, I am trying to give a few explanations to help clear up the confusion that can come with insurance and how the system works. Please, don’t hesitate to ask us questions if you are not clear on how this works. I could write a book of scenarios, but I cannot always anticipate what issues can arise from billing insurance.
I hope this helps to clarify some insurance questions you may have, and certainly ask use more – we want to help you!
Namaste,
Stephanie
*Please note that Alec Baldwin and Tina Fey have in no way endorsed Natural Alternatives Center for Wellness. Although I am quite certain if they visited our center they would be more than happy with their treatments and I certainly welcome them to give us a shout out at any time!