Acupuncture has hit the mainstream. Which means, you may be able to get acupuncture treatment for the cost of your co-pay (deductible aside, of course). If you have been curious to see if acupuncture can help your condition, are inhibited by out-of-pocket costs, or simply want to take advantage of your insurance plan, understanding how to navigate the system can bring treatment within reach.
It's Personal.
One of my two main reasons for going back to school to become a Licensed Acupuncturist (a massive undertaking, if I may say so!) after practicing Clinical Ayurveda and Integrative Herbal Medicine was the desire to accept insurance rather than have my services limited to those who could pay out of pocket. In my own experience navigating life with Ankylosing Spondylitis, a chronic autoimmune disease which inhibited me from working full-time from a young age (I was 19 when the diagnosis came down back in the dark days when pre-existing conditions excluded you from health insurance eligibility in the first place, but that’s another story), I know all too well that if the choice is between paying rent and getting acupuncture, there really is no choice. For chronic conditions in particular, which often require consistent treatment to get better for real, holistic medicine is simply out of reach. And herbs on top of the cost of treatments? Forget about it. It wasn’t until my own insurance covered plan acupuncture that I was able to afford consistent treatment.Â
And, while the medical system now includes a pathway to holistic medicine, that doesn’t mean it isn’t tricky to navigate. So, here’s a step-by-step guide to getting the medical system to work for you.
1. Review Your Current Insurance Policy for Acupuncture Coverage
Begin by carefully reviewing your current health insurance policy. Look for sections that detail coverage for alternative or complementary therapies, which often include acupuncture. Pay attention to terms such as "alternative medicine," "complementary care," or "non-conventional treatments." Note any copayments, deductibles, or limitations on the number of sessions covered per year.
Even with insurance coverage, you may be responsible for copayments, deductibles, or coinsurance. Understand these financial responsibilities upfront to avoid unexpected costs. Additionally, please be aware of any limits on coverage, such as annual caps on the number of acupuncture sessions reimbursed by your insurance plan.
2. Don’t Have Coverage? Here’s How to Find a Plan that Covers Acupuncture
If your current insurance does not cover acupuncture or if you are shopping for a new plan, explore options that explicitly include coverage for alternative therapies. When comparing plans, check the summary of benefits or speak with a representative to confirm acupuncture coverage and any associated costs.Â
3. Find an In-Network Provider
Insurance plans often have networks of healthcare providers with whom they have negotiated rates. To maximize your benefits and minimize out-of-pocket costs, seek acupuncturists who are in-network with your insurance plan.Â
Synthesis Medicine Acupuncture is currently in-network with the following insurance carriers:
Veteran Affairs Community Care Network (VACCN)
United Healthcare plans including GEHA
By the end of the Summer / early Fall, Heather Vaughan, L. Ac. is an in-network provider with the following insurance carriers:
United Healthcare
Cigna Health
Aetna
Veterans Community Care Network (VACCN)
Not sure? Get in touch with me and I can check your eligibility.Â
4. Workers Compensation Coverage
If you are considering acupuncture for a work-related injury or condition, check your eligibility for coverage under workers' compensation. This coverage varies by state and may require approval from your employer’s insurance carrier. Consult with your employer’s human resources department or the workers' compensation board to understand the process for seeking acupuncture treatment under this coverage.
Synthesis Medicine is currently in the credentialing process to take Federal Workers Compensation Patients (OWCP).
5. Understanding Superbills and Reimbursement for Out-of-Network Providers
If you choose to see an out-of-network acupuncturist or if your insurance plan requires it, you may need to submit a superbill for reimbursement. A superbill is a detailed invoice provided by the acupuncturist that includes the healthcare provider’s information, treatment codes (CPT codes), dates of service, fees charged, and any diagnosis codes (ICD-10 codes) relevant to your treatment. It's essential to obtain a referral and necessary diagnosis codes from your primary care provider or specialist to ensure the superbill meets your insurance company's requirements for reimbursement.
6. Appealing a Denial
If your insurance claim for acupuncture is denied, you have the right to appeal the decision. Review your insurance company’s appeals process and gather supporting documentation, such as the superbill and medical necessity statements from your healthcare provider. Be persistent and thorough in presenting your case for coverage.
7. Best Practices to Ensure Coverage & Reimbursement
Keep Excellent Records Throughout the process of seeking insurance coverage for acupuncture, keep detailed records of all communications with your insurance company, healthcare providers, and acupuncturist. Retain copies of referral forms, claim submissions, and any other relevant documents. These records will be crucial if you need to appeal a claim denial or resolve billing issues.
Make Sure Your Referral Includes 1 or More Diagnosis Codes for Pain Some insurance plans that cover acupuncture but require referrals from your primary care physician (PCP) or pre-authorization for treatment. While the landscape is evolving and more conditions are being covered, the safe bet is pain management. This includes headaches, chronic low-back pain, painful menstruation, arthritis, fibromyalgia, injury recovery, neuropathy, and more. The short story - if it hurts, ask you doctor for an acupuncture referral to be on the safe side.
8. What about Herbal Medicine?
Herbal Medicine, including those from Traditional Chinese Medicine, Ayurveda, Western, etc. is not covered by insurance. But, like acupuncture, you may use a Health Savings Account (HSA) to pay for them if you have one. Additionally, with treatments at your fingertips for the cost of your copay or coinsurance, herbal formulas, which run about $14 per week here at Synthesis Medicine Acupuncture in Asheville, may suddenly be within reach. I do my best to work with my patients' financial situations in a very open, practical way. Since you have to eat food every day anyway, for example, adjusting diet does not necessarily impact your finances in the long run at all. If formulas are too expensive, we can do a lot with tea, as another example. The beauty of working with your whole diet and lifestyle is that we have lots of room for resourceful creativity.
Navigating insurance coverage for acupuncture requires a little bit extra effort at the beginning of the process (thorough research, proactive communication, and proper documentation). But after that, you're off to the races. By understanding your current insurance policy, exploring options for coverage, and maintaining detailed records including Superbills, you can increase your chances of accessing acupuncture treatments affordably. Whether you're exploring coverage under your current plan or considering new insurance options, following these steps will help you integrate acupuncture into your holistic healthcare routine effectively. And when the process starts to feel overwhelming or tedious, remember, I’m here to help. Your health is worth the effort.
