Today, one of my patients asked me–Dr.Fan, You are the Provider in My BlueCross BlueShield Insurance Network, Why I have to Pay Acupuncture Treatments?
Here is the answer:
Only when the patient has acupuncture coverage, patient’s insurance may pay the acupuncture fee for patient. Why I say “may” pay for?
It depends on a few conditions:
(1) If patient has HMO, even patient does have acupuncture coverage, the provider is not an in-network provider, patient has to pay by himself/herself;
(2) If patient has PPO(with acupuncture coverage), and without limitation in deductible and illness condition, the provider also is an in-network provider, insurance company should pay for the patient’s acupuncture treatment.
If the patient has a PPO but without acupuncture benefit, patient have to pay out of the pocket. But the insurance may advise the provider to give such patients some extent discount/or just pay a reduced fee;
If the patient’s PPO with acupuncture benefit, but has some pre-conditions, such as acupuncture treating the low back pain only, the patient has to pay for acupuncture treating other conditions, such as upper back pain, neck pain, etc. If the patient has deductible, say, $500, or $1000, even acupuncture is covered, the deductible part has to be met first-pay by patient first.
And the copay(such as $25 or $40) or coinsurance part (such as 10%,20% of the “allowed amount”,etc) is patient’s responsibility.
(3) Another issue is: insurance may cover acupuncture, electric-acupuncture only, other related therapies, such as Cupping, Tuina, Infrared, etc, in the theory, should be paid by patient. However, sometime, the provider may give patient a courtesy–at no additional fee.
Sometime, the flexible spending account could help patient to cover the part of self-pay, save patient’s tax in healthcare part.
