Insurance Billing for Acupuncture: Part II


THE PROCESS

I've explained why I've decided to offer insurance billing for my patients here. Now, let's dive into what it looks like to have your insurance pay for your acupuncture treatments!

[DISCLOSURE: I am still a novice at insurance billing! Here I share with you all that I have learned so far. This should by no means be considered an exhaustive explanation of insurance billing and coverage for acupuncture.]

First, submit your information here. My insurance billers will do their magic and find out your plan's benefits. The breakdown of your benefits will look something like this:

Coverage

Is acupuncture a covered service? This will be a yes or a no. Even if your plan does not cover acupuncture itself, your insurance may reimburse for the office visit portion of your appointment or physical therapies such as cupping. While this reimbursement may not cover the cost of your entire appointment, it can help reduce your financial obligation.

If you have an HMO I will unfortunately always come up as a "no," as I am an out-of-network provider.

Deductible

Do you have a deductible to meet before your insurance will start paying? This value may range anywhere from $0-$5,000. Your insurance will not start contributing to your acupuncture fees until you have spent this amount out of pocket.

Number of Visits

Some plans will only pay for a set number of visits per year. Others may require "medical necessity."

Other factors

  • Some insurance plans won't cover acupuncture when performed by an acupuncturist (imagine that!).

  • Each company has a predetermined "allowable" amount for each service - depending on geographic region, etc.

  • Most plans will only cover a percentage of the allowable amount.

  • Some plans will only cover acupuncture for specific conditions and diagnoses.

So what happens next? Once we know your coverage, schedule your first appointment! At your first appointment, I will collect my cash rate fee as a deposit towards your deductible. After that, you get to lay back and enjoy your acupuncture. My insurance biller and I will deal with all of the wonderful paperwork and communications with your insurance, while you work on healing your body and feeling better!

As with all things insurance, it does take some time. We may be a couple of appointments in before we precisely determine your financial responsibility. It may be none, in which case I will reimburse anything you have paid thus far. Or, you may be required to pay a co-insurance fee, or a portion of the visit.

Find out if your plan covers acupuncture here. And as always, please don't hesitate to contact me with any questions about acupuncture or insurance billing.

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Conveniently located at

North Shore Acupuncture & Wellness

65 Newburyport Turnpike

Newbury, MA 01951

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