Insurance

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In the United States, Traditional Chinese Medicine (TCM) is considered complimentary and /or alternative medicine. Although it’s considered alternative, many health insurance plans DO cover acupuncture treatments performed by Traditional Chinese Medicine (TCM) physicians.

Fill out this form to find out if your insurance covers acupuncture – we will verify your benefits and get back to you within 24 hours.

Here are the answers to some of the questions you might have.

Is acupuncture covered by insurance?

The good news is that yes, many insurance companies now offer policies that cover acupuncture and related services performed by an acupuncturist.

Does my insurance cover acupuncture?

You can find out if your insurance provides acupuncture benefits by calling your insurance company’s patient information or benefits line. This number can be found on your insurance card.

If your insurance provider does cover acupuncture, here are a few questions that you can ask to determine your eligibility and coverage:

How many treatments do I get?
How much does the insurance company pay?
What is the normal co-pay for acupuncture from a preferred provider? (This is the amount you would pay out-of-pocket for each visit to a practitioner on their provider list.)
What percentage will I pay for out-of-network practitioners? (This is the amount you would pay out-of-pocket for each visit to a practitioner who is NOT on their provider list.)
Who must provide the acupuncture?
Will I need a referral from an MD to see the acupuncturist?
What is my deductible?
What conditions are covered for acupuncture? (Many plans only cover the treatment of pain)

What are Affinity Programs for acupuncture?

If you don’t have benefits, you may have what’s called an “affinity program”. This is an arrangement that the insurance company has with certain acupuncturists to offer their members treatments at a discounted price (usually 20% to 40% discount off regular price).

Do Medicaid and Medicare cover acupuncture?

At this time, Medicaid and Medicare do NOT provide coverage for acupuncture.

The California MediCal program offers limited coverage when you see an acupuncturist that is a MediCal provider.

Is acupuncture a treatment option after a car accident?

If you have suffered a personal injury in an auto or motor vehicle accident, your or the other parties car insurance will pay for acupuncture treatments.

How do I bill the insurance companies for acupuncture?

While more and more acupuncturists are signing up to become acupuncture providers for insurance companies and handle all the paper work involved in billing, it is common for practitioners to be paid in full and provide patients with the information they will need to file a claim for reimbursement themselves.

(acufinder.com)

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Patient's Information


Insurance Information


Additional Documentation


Aetna considers needle acupuncture (manual or electroacupuncture) medically necessary for any of the following indications (aetna.com):

Chronic (minimum 12 weeks duration) low back pain or neck pain; or
Chronic (minimum 12 weeks duration) headache; or
Nausea of pregnancy; or
Pain from osteoarthritis of the knee or hip (adjunctive therapy); or
Post-operative and chemotherapy-induced nausea and vomiting; or
Post-operative dental pain; or
Temporomandibular disorders (TMD).
Maintenance treatment, where the member’s symptoms are neither regressing or improving, is considered not medically necessary. If no clinical benefit is appreciated after four weeks of acupuncture, then the treatment plan should be reevaluated. Further acupuncture treatment is not considered medically necessary if the member does not demonstrate meaningful improvement in symptoms.

Aetna considers acupuncture experimental and investigational for all other indications, including but not limited to any of the following conditions, because there is inadequate scientific research assessing the efficacy of acupuncture compared with placebo, sham acupuncture or other modalities of treatment in these conditions:

Acne
Acute low back pain
Addiction
AIDS
Allergies
Amblyopia
Asthma
Attention deficit hyperactivity disorder (ADHD)
Autism spectrum disorders
Bell’s palsy
Burning mouth syndrome
Cancer-induced bone pain
Cancer-related dyspnea
Cancer-related fatigue
Carpal tunnel syndrome
Cerebral palsy
Chemotherapy-induced leukopenia
Chemotherapy-induced neuropathic pain
Chronic pain syndrome (e.g., RSD, facial pain)
Chronic obstructive pulmonary disease (COPD)
Cognitive impairment
Diabetic gastroparesis
Diabetic peripheral neuropathy
Dry eyes
Endometriosis pain
Epilepsy
Erectile dysfunction
Facial spasm
Fetal breech presentation
Fibromyalgia
Fibrotic contractures
Glaucoma
Hypertension
Hypoxic ischemic encephalopathy
Induction of labor
Infantile colic
Infantile diarrhea
Infertility (e.g., to assist oocyte retrieval and embryo transfer during IVF treatment cycle)
Inflammatory bowel diseases (Crohn’s disease and ulcerative colitis)
Insomnia
Intra-cerebral hemorrhage
Irritable bowel syndrome
Menopausal hot flashes
Menstrual cramps/dysmenorrhea
Mumps
Myofascial pain
Myopia
Neck pain/cervical spondylosis
Nocturnal enuresis
Obesity/ weight reduction
Painful neuropathies
Parkinson’s disease
Peripheral arterial disease (e.g., intermittent claudication)
Phantom leg pain
Polycystic ovary syndrome
Post-herpetic neuralgia
Post-traumatic stress disorder
Pruritus
Psoriasis
Psychiatric disorders (e.g., anxiety, depression, and schizophrenia)
Raynaud’s disease pain
Respiratory disorders
Rheumatoid arthritis
Rhinitis
Sensorineural deafness
Shoulder pain (e.g., bursitis)
Smoking cessation
Spasticity after stroke
Stroke rehabilitation (e.g., dysphagia)
Tennis elbow / epicondylitis
Tension headache
Tic disorders
Tinnitus
Urinary incontinence
Uterine fibroids
Xerostomia
Whiplash

Aetna considers acupuncture point injection (also known as acupoint injection therapy, biopuncture) experimental and investigational for the following conditions (not an all-inclusive list) because the effectiveness of this approach has not been established:

Amyotrophic lateral sclerosis.
Cancer-related pain
Cervical spondylosis
Chronic daily headache
Dysmenorrhea (menstrual pain)
Lateral elbow pain (tennis elbow).

 

5 TIPS TO GET YOUR INSURANCE COMPANY TO PAY FOR ACUPUNCTURE

1. Write to your insurance company and your employer

If you have an insurance plan that doesn’t cover acupuncture one of the best things you can do is to write a letter to your insurance company, and to your Human Resources representative if you receive insurance benefits through your employer. Your insurance company can make changes at the next renewal of your policy or risk losing your business, and often your employer is involved in choosing which benefits will be included in a corporate-sponsored insurance policy.

Over the past several months AOMA has been spearheading a letter-writing campaign to national insurance companies and local employers, petitioning them to open their networks more fully to acupuncture coverage. To participate in AOMA’s letter-writing campaign please contact sowenby@aoma.edu and we can provide you with a form letter to send, or call 512-492-3076. You can also speak to a clinic receptionist at your next appointment and they will provide you with a form letter and a stamped envelope. If you would like to give your feedback to your insurance company over the phone or electronically, detailed contact information can usually be found on the back of your insurance card.

NOTE: Some insurance companies like Cigna and Aetna have closed networks, meaning they place restrictions on allowing new providers to join based usually on geographical location. If you are insured with one of these companies you can write a letter petitioning them to open their networks up to AOMA’s providers and allowing you to use your insurance benefits at the AOMA Professional Clinics.

Thank you in advance for helping AOMA to transform new lives and communities!

2. Encourage friends and co-workers to write letters.

If you receive insurance benefits through your employer this is especially important because you need to let your company know that there is a high demand for acupuncture coverage among its employees! With large numbers of employees touting the benefits of acupuncture and asking for it to be a covered service, an employer is more likely to research acupuncture and consider adding it to the company insurance plan.

3. Get involved with acupuncture activism.

Getting involved with acupuncture activism can range from things as simple as signing your name to a petition to joining acupuncturists and acupuncture supporters for demonstration rallies. The Texas Association of Acupuncture and Oriental Medicine (TAAOM) website has information about upcoming events and governmental affairs relating to the practice of acupuncture, or you can contact them for more information on how you can help.

4. Talk to your acupuncturist.

If your insurance company places restrictions on the acupuncture coverage on your policy (ex. Acupuncture for treatment of pain only, a small number of covered visits per year, etc.) please talk to your acupuncturist. They may be able to help you navigate the confusing world of insurance and acupuncture, and can possibly help you get coverage for additional treatments. If you are a patient of the AOMA Clinics please feel free to contact sowenby@aoma.edu for any help communicating with your insurance company or understanding your benefits.

5. Change your insurance policy or company.

If you purchase your own insurance it may be relatively simple for you to change your individual policy, add coverage for acupuncture by purchasing alternative medicine “riders,” or even switch your insurance company. If you receive insurance through your employer, talk to your Human Resources representative to find out if there are different plan types for you to choose from. However, most insurance policies are purchased annually and can only be changed during annual renewal or open enrollment periods.