Does my insurance cover acupuncture?
This is now my number one question asked, when a new patient calls.
Five years ago this question was second only to: Does it hurt?
Today the community of prospective patients has conquered their needle-phobia and are now looking to ease the pain in their wallets. In truth I don’t blame them with a nose diving economy and ever growing insurance premiums, we should all make the most of our insurance coverage.
I can also say that many things have changed in the insurance game in the last few years and that it is much more likely to have acupuncture benefits on your policy now.
How do I know if I have acupuncture benefits?
The simplest way to find out is to give me (or the acupuncturist of your choice) a call with your insurance card in hand. All we need are a few basic pieces of information, your ID number on the front of the card usually (sometimes this has numbers and letters) , your name, date of birth, and the provider relations number on the back of the card. Once we get through the automated phone system and get to talk to someone, ( I normally do this around lunch as it may take some time) we just ask if you have benefits.
If you want to call here are important questions you should ask your company:
- Do I have in network or out of network benefits? In-network benefits means you must go to a practitioner who is a provider for your policy. In some cases there are relatively few acupuncturists in a given area and those practitioner might be Certified Acupuncturists (meaning although they are other health care professionals, they get about a tenth of the training as a licensed acupuncturist) *** I should note that although it has taken some time, some of the bigger providers like Blue Cross Blue Shield are taking Licensed Acupuncturist. I am a provider for them! Out-of-network benefits indicate that your insurance will cover and practitioner, provided that the practitioner wishes to take the insurance. Out of network benefits normally are on the higher end policies, but are more common for patients who’s policies cover acupuncture.
- Are there any limits to treatment? It would be much simpler if acupuncture coverage was a yes or no answer, sadly it is not. After you find out that you have coverage you need to ask if there are any limitations. Limitations that may be included on your policy can include everything from a monetary cap (ie: $1000 per year), a number of visits per calendar year, can exclude certain conditions (they may cover back pain, but not smoking cessation), and may even limit your benefits to seeing certified acupuncturists (yes, it is a touchy subject with me). In most cases, if you have benefits, the insurance representative will list any such limitations. If they tell you something that you don’t understand, please ask them to explain. I’ve called many, many times and have spoken to someone who was either reading the wrong information or clearly didn’t know what they were talking about(If that happens I suggest hanging up and trying again, I know it’s as fun as it sounds).
- What am I responsible for? Yes, even with benefits and coverage you might very well have to pay something out of your pocket. In-network patients will be subject to a Co-pay, which may run between $15-30; in some cases I’ve seen it be $40 which is ridiculous. Out-of-network patients may be responsible for a percentage of the treatment, your insurance may cover 70% leaving you with the remainder, which may be negotiable with your acupuncturist (it can’t hurt to ask). In some cases there may be a deductible, this can be a big or small number depending on you policy, but may also have been eaten up by other health care practitioners, if it is later in the year. Most patients with out-of-network benefits will have some deductible, and I have heard of some in-network policies that have had deductibles, but it is much more less common.
So, what do you do if you found out that you don’t have acupuncture benefits?
If you get your health care through an employer, ask your benefits representative, or HR what you need to do to get them. In some cases you can just alter you policy with your current company, in other cases you may have to wait for open enrollment and change to a different company. If your company doesn’t offer acupuncture benefits demand it. The more people at your office that ask, the more likely they will be to add it.
If you get your benefits on your own ask what policies cover acupuncture and ask about your costs and limitations. You may have to get a new company or you may be able to add the benefit without much hassle.
Here is a list of companies in the Baltimore area who may have Acupuncture Benefits:
Blue Cross Blue Shield
Blue Cross Blue Shield Federal Employee Benefits program
Carefirst Blue Cross PPO
Carefirst Blue Choice PPO
Johns Hopkins Employee Health Benefit (especially the PPO)
Great West (now a division of Cigna)
Some Cigna policies (I’ve had problems dealing with them before)
United Health Care PPO
Atnea (usually the high end policies)
Please remember that if you don’t see your company listed or don’t know if you have benefits on your plan, just contact me, firstname.lastname@example.org , and I’ll gladly check for you.