Acupuncture and Insurance Questions & Answers
Over the past year, I have received a lot of email questions regarding network status, verification's, etc.. Below I have answered those questions and more.
My Clinic does call to check insurance benefits. The usual turn around time is 24-48 hours.
Please provide the following information:
• The name of the insurance company
• ID number
• Your name
• Your date of birth
• Phone number for provider (on the back of the card)
If you decide to call on your own, I can provide you with a more extensive insurance benefits questionnaire to guide you through the call. In brief:
Here are the basic questions:
•. Do I have Acupuncture benefits?
• Can I get Acupuncture for ___________ (state whatever you are coming in for)? Most plans only cover acupuncture for pain or in lieu of anesthesia.
•. If the reason visit requires a diagnosis code , you can reference an ICD10 manual online: Here is a linked example: CareCloud
• How many visits per plan year am I eligible for?
In Addition:
•. If you are coming in for fertility support, the most common diagnosis code (ICD-10) for female infertility is N97.9. Ask them if they cover acupuncture (CPT Code 97810 and 97811) for fertility and give them these codes.
•. If they say yes, write down the call reference number.
•. If I am not participating in your network, you may have out of network Acupuncture benefits.
• You can use your HSA or FSA card for Acupuncture if I am out of network with your health insurance plan. Acupuncture is covered under the Savings Accounts, regardless of the reason visit.
•. Know that if I bill your insurance and your insurance ends up denying your claims, the cost will end up being much higher than if you paid on the day of your visit and got "the time of service" discount, which I can only give at the time of service. This is why I verify benefits before you start treatment.
• I bill your insurance and count treatments but it is ultimately up to you to know your benefits and to keep track of how many visits you've had so that you know when you have run out of benefits for your "benefit year" (which may not be the calendar year).
• I will not be able to offer the time of service discount after insurance has been billed, in the event that your insurance denies the claims.
• If I am a provider for your insurance but you choose not to bill for the above reasons, please let me know.
Below is a list of common plans I bill. This list is not complete and I am happy to bill any insurance, even if they are out of network.
Colorado Acupuncture Studio accepts and bills the following insurance plans:
•. Aetna: Not participating- Out of Network.
•. Cigna: Not participating- Out of Network
•. Humana:In Network
•. Kaiser Permanente: All Providers are considered cash pay even in house.
Therefore the plan will dictate your out of pocket, usually comparable to Cash rates. There is one exception- the senior plan. This is a copay plan.
•. Medpay and Workers Comp: Available
•. Blue Cross Blue Shield : Not participating- Out of Network
•. Medicare Advantage: In Network with Most Plans and covered only for Lower Back Pain
•. Medicare: Not participating- Out of Network - The government has not recognized Acupuncture as a valid health care profession.
•. Triwest: In Network
•. UnitedHealthcare: In Network
Costs without Insurance (Time of Service Discount)
120-140 Minute Fertility Acupuncture Consultation and Treatment" $240
90-120 Minute Initial Acupuncture Consultation and Treatment: $199
45-60 Minute Return Acupuncture Appointment: $99
Time of Service appointments can be paid with an HSA or FSA Card, Credit Card (all major brands accepted), Zelle, Cash or Personal Check.
Adjunct treatments like cupping, herbal prescriptions, and Moxabustion are also available a la carte. Please reach out if you need a treatment without Acupuncture to find out more about the cost and time required of these services or self service online.
If you have any further questions, please call me and I am happy to give you guidance.