How to Verify Acupuncture Benefits With Your Health Insurance Company
I am able to work with a wide variety of insurance providers by providing you with a “superbill” upon request. If you would like to make use of this service I recommend that you check with your insurance carrier prior to your appointment with me to be sure that superbills are accepted. If you would like to have insurance cover all or a portion of your treatment I recommend that you contact your insurance provider to learn the covered benefits of your policy with respect to Traditional Chinese Medicine including acupuncture. I also recommend that you ask them in detail the extent of your benefits. In an effort to make this process an easy as possible for you I have devised a list of 8 simple questions you should ask your insurance carrier when you contact them. Write down all of the answers, the dates and be sure to get the name of the person you spoke with. Please bring this information with you to your first appointment.
The below questions may seem overwhelming at first, so have a cup of tea and prepare to not only educate yourself about your own policy but to be empowered by taking the driver’s seat on your own self-care.
8 SIMPLE QUESTIONS FOR YOUR INSURANCE CARRIER
If you ask the representative a question about CAM (complementary alternative medicine) benefits and they seem unsure, call back and ask to speak with someone else. The information should not sound like a “gray” area. If it’s covered it should be clear to them and to you. If you ever get conflicting information simply ask to speak with a supervisor.
- Does your policy allow you to submit a superbill for reimbursement of covered benefits?
- Is there any difference of coverage between going to an in-network or out-of-network provider with regard to acupuncture benefits?
- Are there restrictions on CPT codes? CTP codes are just the codes for what was done. For example, your plan might cover manual acupuncture but NOT electro-acupuncture. These different types of treatment use different CPT codes. You want to know this ahead of time. These little distinctions make a difference on whether or not you will get reimbursed. You don’t have to know the terms, they should tell you.
- Is there a list of covered and non-covered diagnoses for CAM (Complementary Alternative Medicine) providers? You won’t necessarily know your diagnosis, but you will know why you are coming to see me (headache, back pain) Whatever the reason you are seeking treatment you want to ask them if there are limitations on things they cover for acupuncture and things they don’t.
- Are there any licensing restrictions on who can perform the treatment? Oddly, some policies only cover an acupuncture treatment performed by an MD. MDs can practice acupuncture after completing a 1-weekend course, whereas acupuncturists are trained in the theory of Chinese Medicine and the practice for about 4 years. As backward as that sounds, you will want to know any such restrictions in advance even if this type of treatment are covered.
- What is the maximum coverage for the treatments you are seeking? You want to know the maximum number of treatments per year or per condition per calendar year. You will also want to know the dollar value amount allowed for these types of treatments. Your policy may say that acupuncture is covered but covering it comes from the same fixed dollar amount allowed for chiropractic or physical therapy. If you have already had these other services you may have spent your maximum allowable amount already for that calendar year.
- Where should you send the superbill and any necessary supporting documentation? Don’t assume the address on your card is current. CAM (complementary alternative medicine) claims sometimes should be sent to a different address than other claims.
- Is there anything else you should know? Before you hang up feel free to ask them if there is anything else you should know about your acupuncture benefits. Is there anything they can suggest that you have not discussed to help ensure the reimbursement go smoothly?