Acupuncture and Insurance Coverage
Insurance coverage doesn’t have to be a source of stress… read on below to find out how to leave it to me!
Will your insurance cover your acupuncture sessions? Maybe! Whether you’ve been referred by American Specialty Health, Aetna, or another plan, it’s possible that your insurance may pay for your visit, leaving you responsible for only a co-pay. However, there are some important details to know:
I’ll need to verify your coverage first. Even if you were sent directly to me my your insurance plan, they often get it wrong. Many Kaiser plans will only cover acupuncture given in a Kaiser facility. Other plans include chiropractic coverage but not acupuncture, but don’t clarify that in the referral. Some Anthem plans will only cover you if you get access via American Specialty Health. Leave it to me! Just submit your insurance info on my secure form, and I’ll verify your coverage. I’ll text you once I know the details, and then you can schedule with peace of mind.
Coverage isn’t for everything, but only for what the insurer (not your doctor) considers ‘medically necessary.’ Each insurer has its own rules about what qualifies as "medically necessary." My process is always holistic, so I do a full evaluation when you begin care with me, during which time I’ll assess you for all conditions, which may include covered ones. For example, coverage may be for:
A wide variety of musculoskeletal pain conditions, as well as migraines, nausea, or cancer-related pain (ASH plans)
A few chronic conditions like back, neck, knee, or hip pain (some Aetna plans)
Only very specific types of chronic back pain, or for pain conditions that persist after trying medications and physical therapy. (CMS Medicare plans)
The number of treatments they’ll cover will be limited. Even if your condition is covered, the insurer may limit the number of acupuncture visits considered "medically necessary" for that condition, regardless of whether your plan lists 20, 30, or "unlimited" visits per year. I can almost always get at least 8 before I have to start making a case for continued covered care.
What I can do to help: After I verify your coverage, I will work to maximize your insurance benefits within these restrictions, and let you know when/if your coverage runs out for your condition.
Remember: My affordable out-of-pocket scale is always available! If insurance won’t cover further treatments or cover your particular condition, you can always get care using our sliding scale fee of $30–$50 per visit. The sliding scale allows you to decide how much acupuncture you want, what you want to work on, and how frequently you’d like to come in. I love the sliding-scale community model because it puts the decision-making power for this incredible healing tool back into your hands where it belongs?
Get in touch! Head over to the insurance page to submit your insurance info, click here to book a session, or feel free to just send me a quick text with your questions.
