I would love to bill insurance for acupuncture and every other modality I use for every patient and every treatment. The sad truth is: private insurance companies, Medicare and MediCal make this very difficult or impossible. For years I was in-network with several insurance companies. But, like so many large systems the problems of getting paid became another full-time job.
Private insurance companies have fee schedules which all in-network practitioners agree to accept as payment in full, with the patient’s co-pay. Fee schedules (contracted amount insurance pays per treatment or procedure) has remained the same for over 10 years! Yes, what in your life costs the same now as it did 10 years ago? Insurance companies raise our rates yearly telling us, the consumer (member), costs have increased. Their payment to acupuncturists has not. One of the lowest rates in California is Anthem Blue Cross – the insurer for CalPers and many other large employers in California. Their maximum fee for an acupuncture treatment is $40. It is impossible for private office acupuncturists to keep their doors open with that fee, unless they are seeing multiple patients simultaneously.
MediCare and MediCal do not pay for acupuncture. Medicare is currently conducting studies on the effective use of acupuncture for low back pain. Some Medicare supplemental coverage says they cover acupuncture, however when I have called for verification of this, I have been told if Medicare does not pay for it, they will not either. I thought supplemental insurance is to pay for what Medicare doesn’t. This situation has been most prevalent with United Healthcare – yes, that enormous corporation which is connected to AARP.
What to do? If you have an HMO or EPO insurance plan, you must see only in-network practitioners to not pay out of pocket for services. If you have a PPO plan it is possible your insurance company will pay most of the bill. Each insurance company and plan has its own peculiarities.
The Superbill is a receipt with the practitioner’s name, NPI (national provider identification), diagnosis and procedure codes. In the situations where the practitioner can not bill for services, because the chance of getting paid is slim or nil,
patients can use this receipt. First submit it to your insurance company – they might reimburse you. Keep it for your tax records – it’s possible you can use it as a deduction.
*This information is to answer the many queries I hear on this topic.
