Insurance

The issue of insurance coverage can be a complex one. However determining acupuncture coverage you just have to know what to ask when calling. 
 

The following are some questions that you can ask your insurance company when determining your benefits. Insurance is regulated on a state level in the USA and under what policy or plan you have with them.
 

1. Call your insurance company's consumer or benefits line. This number will likely be found on your membership card. Inquire about your acupuncture benefits.
 

If you don't have benefits, you may have what's called an "affinity program". This is basically saying that if you pick an acupuncturist off of one of their lists, you can get your treatments at a discounted price. The discount will vary from plan to plan.
 

2. If you have benefits, you need to ask the following and make notes of it:
 

A. How many treatments do I get? They can be unlimited, 20-30 visits per year, all depending on your policy plan.

B. Does this number also include any other therapies? Because some will include the use of chiropractic, physical therapy, or other therapy that are combined to your yearly covered visits.

C. What's my deductible?

When the acupuncturist files your claim, but you haven't met your deductible, your insurance company will not pay your acupuncturist and you will be liable for that unpaid portion. The amount that your insurance company would have paid your acupuncturist will however be applied to your deductible paid, so you'll at least get credit for that amount. Still, there may be some discrepancy between what you pay and what they'll apply to your deductible. You might want to ask about that too.

D. Which Acupuncturist can provide the service?  That depends on who your insurance company again.   You might only allow to see practioner within the HMO network or they allow you to choose any out of network practitioner. 

E. Which problems are covered? Majority of the California Insurance has no restriction but there are some that only cover pain related cases. 

If you still have questions or need help feel free to contact us for assistance on determining your benefits. 

Best to provide our office with your information prior to your first visit so that we can verify your benefits. To add to the complexity, a verification of benefits does not guarantee coverage by your insurance company.

Once we bill your insurance company, you will be responsible for any amount not covered by your insurance company. There is a significant difference between the overhead costs associated with billing insurance and the discounted Time of service fees. In some cases, your insurance company may reimburse only a very small amount which now leaves you accountable for a much larger amount than you would have been had you opted for the TOS fee. In this situation, it may be best for you to elect the option of paying at Time-of-Service and then use a super bill, which we provide and will submit for you, to request that the insurance company reimburse you directly. Feel free to discuss what’s best for you with us.

We are considered by most PPO's to be "Out of Network" providers. Please be aware that we are not members of any HMO (including American Specialty Health) because these companies mandate less time spent with the patient (about 6 minutes) as well as dictate which treatment modalities can and cannot be used regardless of what the patient needs as determined by the healthcare provider.

Workers Comp Cases:
We are accepting Worker's Comp patients, however we prefer not to be the primary and we require a pre-approved prescription for acupuncture treatment prior to accepting the case from your primary physician.