How to Verify Your Health Insurance Coverage For Acupuncture Treatments

Many health insurance companies offer full or partial coverage for acupuncture treatment. However, they may not openly disclose which types of treatment they actually pay for unless you ask the right questions. Each patient's policy is unique to that patient. So are the benefits.

To get a complete and accurate picture of your coverage, call the patient information number on the back of your health insurance card. Then ask the following questions, step by step.

1. Does my plan have an Acupuncture benefit?

2. What is my "annual deductible"?

3. What is the unpaid portion that I still have to pay before my insurance coverage kicks in?

4. Does my Acupuncture benefit cover my medical diagnosis? Make sure you name the pathology over the phone, for example, diabetes, hypertension, essential tremors etc. Many plans only cover "pain syndromes"; if so, ask what types of "pain" are covered?

5. How many treatments do I get? Are there any limits on the number of visits for my condition?

6. Who must provide the acupuncture? Is an MD or chiropractor required?

7. Will I need a referral from an MD to see my acupuncture physician?

8. Given my plan, how much does the insurance company actually pay on the first acupuncture treatment?... on follow-up treatments?

9. What is the normal co-pay for acupuncture if I use a preferred provider? This is the amount you would pay out-of-pocket for each visit to a practitioner who is not on their "in network" list, but who is on their "preferred provider" list.

10. What percentage would I pay for a practitioner who is " out-of-network"?

That's all there is to it. Once you have the answers to the above questions, you will have a clear understanding of how your insurance supports your health care needs. It is important to keep detailed records about all contacts you have with your insurance company, including call notes, copies of bills, claims, and letters. These records will assist you if a dispute arises about a conversation you had or a claim. If you are not happy with the representative's explanations or your service or your policy coverage, let your insurance company know. You pay a lot of money for your policy, and it's important that you know the terms better than anyone else and are satisfied with your coverage.

If you don't have coverage as outlined above, you may have other insurance options, such as an "affinity program". This means that if you pick an acupuncture physician from one of your insurance company's lists, you can get your treatments at a discounted price. The discount may vary from plan to plan, so ask what the discount is for your plan.

Many acupuncturists have signed up to become providers for insurance companies. Only a few handle all the paper work involved in billing. Some clinics, including our own, ask for full payment at the time of service. If you are covered by insurance benefits for acupuncture, the clinic then submits the claim on your behalf, instructing the insurance company to reimburse you directly. It's that easy as well as cost effective.

One final issue with regard to Medicare and Medicaid, as well as PIP auto insurance in Florida: None of these programs currently provide coverage for acupuncture. If you want this, please join us in asking for it. Every voice counts.

Article Source: Melinda Leeson, DOM.

1 comment:

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