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Acupuncture and Health Insurance

Acupuncture and Health Insurance:
Pulse diagnostic closeupFrequently asked questions about insurance for Acupuncture services

Laura Loterszpil is a practicing provider with Blue Cross Blue Shield, Aetna, and Cigna.

Unfortunately Medicaid and Medicare DO NOT cover acupuncture.

If you belong to either of these plans my insurance biller will submit claims for you as a courtesy service.

However, please make sure that prior to your first appointment you call your insurance provider to verify if your insurance plan covers acupuncture.

It is much easier for YOU to call and inquire than for me or my insurance biller to do so ; and in the end you are the one who benefits the most truly and of course know you are responsible for paying services whether through insurance or out of pocket.

Remember some plans will cover your services Out of Network:

Ask Your insurance carrier if they cover Out of Network Acupuncture.

In that case I will give you myself an Insurance statement for you to submit with a claim form from your Insurance carrier.

About Your Coverage:

Insurance benefits for acupuncture can widely vary. When you call your insurance to verify acupuncture benefits please be sure to ask the following:

Does my insurance covers acupuncture treatments?

Remember there is a difference between your insurance having a “wellness discount plan” which usually means a 25 percent discount plan versus full or partial coverage after you hit your deductible.

Acupuncture gets covered for limited conditions :

Ask your Insurance if they will cover for the reasons you are wanting to come. If not you can of course still come but just have to pay our of pocket.

Are there any exclusions to my acupuncture benefits?

Yes, for example some plans only cover “ acupuncture for the use of anesthesia” which is old language that some plans still use but is being ruled out since we don’t use Acupuncture for Anesthesia in the United States.

This means your plan does cover acupuncture BUT you won’t be able to use it.

Aetna especially has this so if you have Atnea ask them specifically. Another exclusion can happen with some Federal BCBS plans where they only pay for acupuncture that is provided by a “physician” meaning an MD, medical doctor.

Do I have a deductible to meet before insurance will cover acupuncture?

Ask your insurance if you have a deductible which means you must pay the first a certain amount of dollars before you start getting covered. Deductibles can range fro $0.00 – $6500.

The amount that goes toward your deductible is the amount your plan considers the “usual and customary” fee for services provided.

Do I have a copay that I am responsible for?

Ask your insurance what is your co-pay which can range from from 0-$40 or a % of the fee such as 20% copay. Once we hear back from your insurance we can establish this financial partnership and agreement.

Do I have co-insurance that I am responsible for?

Some plans – though not many – also have a co-insurance that you are responsible for as well as a copay.

Is there a limit on the number, or dollar amount of visits for acupuncture treatment?

Yes, it will either be a dollar amount or it will be a number of visits per year.

Does my coverage renew every calendar year, or does it renew on the anniversary of my coverage date?

Yes, Either January – December, or another time in the year. in our experience the other benefit years we see are April – March, or July – June.

Cancellation Policy

Time is incredibly valuable, unless you have a true emergency no shows before 24 notice is a $85 fee so please make sure you give us enough notice so you will avoid the cancellation fee.

In wellness

Laura Loterszpil