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 will the patient’s insurance “may” pay the acupuncture fee for patient. Why do I say “may” pay for?
It depends on a few conditions:
(1) If patient has an HMO, even if the patient does have acupuncture coverage, but the provider is not an in-network provider, the 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, then insurance company should pay for the patient’s acupuncture treatment.
Should the patient have a PPO but without an acupuncture benefit, the patient will have to pay out of 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 has an acupuncture benefit, but has some pre-conditions, such as acupuncture treating the low back pain only, the patient will have 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 (paid for by patient prior to PPO paying).
And the co-pay (such as $25 or $40) or coinsurance part (such as 10%, 20% of the “allowed amount”, etc.) is the patient’s responsibility.
(3) Another issue is: insurance may cover acupuncture or 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.
Another very important issue is that if the patient has acupuncture benefit, most of the insurance companies define that acupuncture is only for chronic pain management, but some insurance plans are for “acupuncture anesthesia” (which means only during surgery—actually this is a “joke” in the USA as there is not any licensed acupuncturist doing acupuncture anesthesia—the insurance company gives you a benefit which does not exist at all).
So, for acupuncture treating infertility, depression, etc. (without the pain), insurance will not pay for that.