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Dr.Arthur Fan has been rated as one of  “top acupuncturists” in Washington DC and northern Virginia area in the Website: www.RateMDs.com.

http://www.ratemds.com/filecache/topTen.jsp?city=WASHINGTON&sid=8

Best Rated Acupuncturists in WASHINGTON, DC
1 Tetsuhiro Ueno – Arlington
2 Yong Chen – Bethesda
3 ARTHUR FAN – VIENNA
4 SUZZANNE LOHR – WASHINGTON
5 ROCCO MANZIANO – SILVER SPRING
6 BK Mudahar – Washington
7 KERRI WESTHAUSER – BETHESDA
8 Wei Peng – BETHESDA

Best Rated Acupuncturists in herndon, VA
1 Tetsuhiro Ueno – Arlington
2 ARTHUR FAN – VIENNA
3 James Larmour – FAIRFAX
4 Rachal Lohr-Dean – Chantilly
5 SATORI POCH – RICHMOND
6 EUGENE ZHANG – FAIRFAX

Best Rated Acupuncturists in mclean, VA
1 Tetsuhiro Ueno – Arlington
2 ARTHUR FAN – VIENNA
3 James Larmour – FAIRFAX
4 SUZZANNE LOHR – WASHINGTON
5 BK Mudahar – Washington
6 SATORI POCH – RICHMOND
7 EUGENE ZHANG – FAIRFAX

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There are NO direct answer.

The amount of deductible, copayment and co-insurance part are various very much, it depends on your specific plan.  So, you could call your insurance plan to find them acurately.  Of course, some insurance companies provide online check-up service, so you could see it online and print it.

Deductible is your self-pay part before your insurance starts to pay; Copayment is the part you pay each time at the provider’s office (such as $10-30) when you visit them; Co-insurance part is the percentage insurance set for your responsibility.

For exemple, if the patient has $400 at deductible part, $20 for copay and 20% for co-insurance, that means–when he or she starts to see an licensed acupuncturist (in-network), patient should pay $400 first before insurance could start to pay (the first evaluation and treatment, second treatment……untile meet $400 patient self-pay; but if the patient already saw another provider, met some portion of deductible, he or she will pay less than $400). In the first evaluation session, patient also needs to pay $20 copay, but not for treatments. When insurance starts to pay, patient also needs to pay the 20% part at the insurance fee schedule (not the provider charged amount).

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Every insurance company, even same insurance but different plan, pays acupuncture treatments very differently. Some paid more than $100 per session, some around $90, some around $70, some only $25 –even lower than the copayment for other treatments, for example, for Physical Therapy in some cases.

The fee schedule in some insurance companies are based on their surveies, they may set a fee schedule – 80% of average level of last year. i.e. if the average charge of acupuncture treatments in last year was $110, then their fee schedule would be $88 in this year.  The CareFirst BlueCross BlueShield likes this.  However, a few other insurances pay at so-called negotiating price, for example, if the provider charges $110, they may negotiate with the provider at 75% of the billing price, so their payment will be around $80.

Of course, another factor affects the insurance payment to the providers is patients’ premium paid to insurance company each month. If you paid low, the fee supposed to pay to the providers by patients’ insurance should be lower, and patients may also need pay higher deductible, higher copay, and even some percentage of the fee to the provider.

Actually, insurance company pays acupuncture according to how many small sessions in a whole session. So, you could see each whole session may include in two or three different CPT code-97810,97811 or 97813, 97814 depending on how complicated the treatments(how many problems the acupuncturists handled in a whole session).

Another factor is the way of representatives processing the claims, based on the understanding the policy in different way, they may process the same claim very differently.  So you may see the different results, when different representative process the same claim–it  occured in some insurance plans.

Do not be over-stressed with the balance between the insurance payment and the provider’s charge.  In most cases, you do not need to pay it—if this provider is a in-net-work provider, that means he/she accepts that insurnce agreement-do not charge the balance to patient.  However, the patient should pay the deductible part, copayment and the fee for other than the acupuncture, for example, herbs.

In the theory, the providers should charge the fee for cupping, tuina(therapeutic massage), etc.  But sometime, they do not–just for a coutesy treatment–if insurance does not cover it.

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The discussion below is only for the patients who have NO acupuncture benefits. If the patients have acupuncture coverage, please read other information in our blogs regarding to the insurance issues.

Different in answers.

When some patients come, they hope we could give them a very low price for acupuncture–if their insurance plan does not cover the acupuncture. They actually have no idea about how much acupuncture price should be.

How much? around $40-50?—acutually, their expectation is, the acupuncture self-pay price is just a little bit higher than or close to the copayment (for example $20-35) in their insurance plan for other medical specialties when they have NO acupuncture coverage in their insurance.

In current market, the average price or cost  for human patients in Washington DC/ Northern Virginia is around $65-110 (do you know how much-if your pets,dog or cat, need to do acupuncture? the Vet-doctors’ fee schedule is–the first session $250, next $125. Much higher than human patients’ payment for acupuncture services). Some acupuncturises may charge $50-60, some may charge more than  $100.  Some also charge initial visit in additional,$40 -100(or more) because the examination/evaluation and paper works.  Some give patients who have no acupuncture coverage in insurance or senior an additional discount.  Some do not. Some offer a free initial visit.

Considering the price, we should think of:

(1) the actual cost in conventional medicine; for example, the treatment for low back pain, how much for the overall price for an operation/surgery? how much for the overall cost of physical therapy? or how much for the overall cost of Chiropractic treatment?

If we consider the cost/effectiveness ratio, acupuncture overall value actually very high.  It means you pay less and get a good result, with less side effect too. That means acupuncture therapy is less expensive one.  But when patient considers their self-payment, they may feel it is high, that is true—if insurance could cover, patients only need to pay the deductible, and copay. i.e. patient think it is high, it is higher than the copayment, but it is much lower than the actual cost in conventional therapies.

(2) the provider’s condition; if we consider the provider’s costs in training, getting experience, the high level / better provider may have better result, or say, patient might see the effectiveness earlier.  So, paying a little bit more to get a better result is not a bad idea.  In a overall view, patient maybe still save money.

(3) see how many therapies, time  or efforts the provider using for patient; if the provider used acupuncture alone 20 mintues for you and charged $80-90, it may be a little bit high;  if use 40-60 minutes, it is valuable;

If the provider uses comprehensive therapies, such acupuncture with electrical therapy, infarared, cupping, tuina, etc., which would be very valuable and patient may see the effectiveness much earlier.

The price should reflect the value– the technology, training and experience level, treatment time, effectiveness, and other costs, such as office running cost, etc.

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For choosing a proper acupuncturist or a doctor in Chinese/Oriental medicine(CMD or OMD), we could consider a few conditions:

1. How complicate your illness or disorder?

if you have a common problem, such as a low back pain, you could look for any licensed acupuncturist, certified acupuncturist who has MD, DO, or DC license. If your condition is a complicated or you want to look for a “good” / “Top” acupuncturist, or doctor in Chinese medicine, you may search online, ask other people’s opinion, and then compare more provider candidates carefully.

2. What specialty or experience you want he/she has?

Your condition may be complicated, you think you should see a specialist; but you also need to consider your condition belongs to which specialty. For example, if you have infertility issue, you need to see a CMD/OMD who has special training for fertility treatment in Chinese Medicine, instead to see any an acupuncturist or a MD who has less training in Traditional Chinese Medicine(TCM), esp. TCM gynecology. If you have a neurological issue, just call the providers and see who has both Chinese medicine and neurology backgrounds. TCM has many specialties, instead of acupuncture only.

3. How much you want to spend?

A good doctor/specialist may charge you more, but maybe more effective than others. If you have insurance coverage for acupuncture, it is helpful.

4. How many services will the provider provide?

Some of acupuncturist only provide acupuncture only, some may provide more. For example, if you see a CMD who provides acupuncture, electricity therapy, cupping, tuina, even herbal therapies, the price just higher a little bit than others who only provide acupuncture, you will get more benefits and could see the effectiveness earlier-absolutely the comprehensive therapies are better.

5. How far you see him/her?

If you have a common problem, just need to see an acupuncturist nearby.

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Hello world!

Dr Arthur Fan 樊蓥
Dr Arthur Fan 樊蓥

Welcome to Dr.Arthur  Yin Fan’s Blog.

Dr.Fan is a leading acupuncture specialist ad Chinese Medicine Doctor in Northern Virginia, Maryland and Washington DC.   Here posted are articles written or selected by Dr.Fan.

Please check the categories part, and seach specific articles. Thanks!

McLean Center for Complememtary and Alternative Medicine, PLC

Office Address: 8214 Old Courthouse Rd, Vienna, VA 22182.

His official website is www.ChineseMedicineDoctor.us.

His office phone number: (703)499-4428.     

E-mail: ArthurFan@ChineseMedicineDoctor.us

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