Insurance and Acupuncture: What You Need to Know
While some people still think of acupuncture as an exotic treatment that is only for the rich elite or the extremely eclectic, the reality is that this is a valid treatment for many kinds of muscle pain, as well as such conditions as asthma and bronchitis. It’s also been recognized as such by the World Health Organization (WHO) for many years, lending it an air of credibility that other forms of Eastern medicine don’t always have in the Western world.
Many medical clinics have on-staff acupuncture practitioners, as do many chiropractic offices and therapeutic massage clinics. As popular as this form of treatment is, however, one thing that is still not standard is insurance coverage for it. Many major insurers will cover acupuncture only if it is performed by an MD, while others will cover it, but require that your primary care physician refer you in order to do so.
Here are some frequently asked questions regarding insurance and acupuncture:
- Does my insurance cover acupuncture? It might, or might not. The best thing you can do is call the number on your insurance card and ask. You’ll also want to find out whether or not your usual co-pay applies, or if you have to pay up-front and request reimbursement.
- How many treatments can I have? This varies depending on your coverage. The best answer you can expect is “unlimited,” and it will range down from that to 18-35/year, 12-18/quarter, 12-18/year or, if you live in California and are on MediCal, 2/month. When you ask this, be sure to confirm whether these numbers are ONLY for acupuncture, or if they include other therapeutic treatments (chiropractic, physical therapy) as well.
- Do I need a referral? If you’re part of an HMO or PPO, you may have to have a referral in order for your insurance to cover any part of your acupuncture treatment.
- Can I pick my practitioner? Again, if your insurance is through an HMO or PPO, you may have to find in-network acupuncture practitioners in order to have any coverage at all. The good news is that many acupuncturists are forming relationships with medical networks, which not only puts them on the “preferred provider” lists, but also means less paperwork for you.
- What conditions are covered? Many insurance plans only cover acupuncture for the treatment of pain, while some cover it as a therapeutic option for upper respiratory conditions, migraine headaches, and other conditions.
- What if I only have Medicare or Medicaid? Sadly, neither Medicare nor Medicaid offers coverage for acupuncture. However, if you live in California and are covered by MediCal, you do have limited coverage. You have to have a referral, and you are limited to 2 treatments per month, but it’s better than nothing.
What if I’m Not Covered?
Major insurance companies which offer acupuncture coverage on at least some of their plans include Blue Cross, Blue Shield, Aetna, and First Choice.
If your insurance plan doesn’t offer actual coverage for acupuncture, check to see if they have an affinity program. This means that if you pick a practitioner from your provider’s list, you won’t be covered, but you will get discounted services, saving you some money.
Why Aren’t I Covered?
Insurance companies use many techniques in order to determine what is and is not covered by their plans. Treatments must be approved by several agencies, just as the FDA must approve drugs for use before they can be provided. As well, unless there is a demand for a certain kind of treatment – whether it’s acupuncture or anything else, insurance companies won’t add it to their plans. This is because in order for them to pay OUT in the form of benefits, there have to be enough people paying IN to make it cost-effective.
It’s also important to remember that insurance is about risk. New treatments are inherently riskier than tried and true methods. This is why there are studies done whenever new therapies, and even new surgical techniques, are considered.
If your plan does not currently cover acupuncture, consider beginning a campaign to get it covered. Write letters. Make phone calls. Get involved. For many years, annual mammograms weren’t covered by insurance. That they are now is due to the fact that patients and policy holders demonstrated a need. In short, they created demand.
How Much Does Acupuncture Cost?
Acupuncture fees vary widely depending on where you live. In some places the going rate is $75 / hour. In other places, the fee is much higher, and in some states, it’s lower. If cost is a concern, and you have neither an affinity program discount nor insurance coverage, you may want to call different practitioners. Do remember, though, that you get what you pay for – that low price advertised in the Yellow Pages may mean poor service.
Acupuncture is becoming increasingly popular as a pain management technique, especially after auto accidents (your auto insurance may cover it, by the way, even if your health insurance does not), and as a form of therapy for many other conditions. If you have the option to avail yourself of it, consider doing so. Just remember to call your insurance company and confirm coverage first.