Why Doesn’t My Acupuncturist Take Insurance?

So, you’re pretty excited that your insurance plan covers acupuncture. You’ve never had it, but you’ve heard great things about all of the disorders that acupuncture can treat. Besides, it’s natural medicine and hopefully acupuncture will help you reduce the amount of medications you are currently taking. You decide that this New Year, you want to give it a shot. So, you get online and look for some acupuncturists in your area. You find 5 of them within a 10 mile radius. After calling each and every one of them, you find out that none of them accept your insurance. In fact, none of the acupuncturists accept any insurance.  How can this be?

Well, let’s go through some of the reasons why your acupuncturist may not accept insurance.

1.  Insurance billing is tedious.

Your acupuncturist may be a sole proprietor. They are wearing many hats, trying to be an acupuncturist, accountant, inventory manager, advertising & marketing person, etc. Learning to bill insurance requires time, money, and patience. Insurance companies do not make it easy for doctors to get reimbursed through insurance. In fact, there are vocational schools that offer a 3-12 month certification programs just for medical insurance billing.

Also, insurance companies will not reimburse the acupuncturist/doctor/etc. if there is an error in the form submitted to them.  The incorrect form is noted by the insurance company and set aside.  Nothing happens until the doctor calls to ask why he/she has not been reimbursed. The acupuncturist must stay on top of all of the forms submitted to make sure he/she gets properly paid from the insurance company. Of course, on the flip side, if insurance billing is done correctly, the time spent here may be minimized. Overall, adding insurance to an acupuncture practice requires another set of obstacles and concerns that your acupuncturist may not want to take on.

2.  Insurance companies don’t reimburse very well.

Insurance companies want to pay out as little as possible. They are a for-profit company and they want to keep their margins up. They will pay what they consider to be “normal and customary”. Many times, what the insurance company thinks is normal and customary is less than what the acupuncturist must charge to keep their doors open for business.

Consider that across all medical fields insurance is reducing the reimbursement. Doctors are getting paid less for their patient care. Combine minimal reimbursement with the requirement of additional clinical charting and billing paperwork and you have a situation that many acupuncturists would rather avoid than embrace.

3.  Insurance companies limit coverage for the health problems they believe acupuncture can treat.

Health insurance companies control and limit access to your options for health care. They restrict your ability to make health care decisions on your own. They will only pay for what they believe is “medicine”. Your insurance company may be opening its benefits to include acupuncture because they want a piece of the $34 billion out-of-pocket money that Americans are  putting towards alternative healthcare. But, most insurance companies will not cover your acupuncture visit unless it falls into one of these categories:  chronic back pain, migraines, morning sickness from pregnancy, postoperative nausea from chemotherapy or temporomandibular joint (TMJ) pain.  (Please check with your insurance company’s acupuncture policy for further information.)

Some acupuncturists do not like the fact that insurance companies state that acupuncture treatments for conditions outside of their coverage is considered “experimental”. Many licensed acupuncturists (LAc’s) believe that insurance companies should not be the ones controlling health care options for the consumer. By the acupuncturist accepting health insurance, they believe that they are supporting the insurance companies along with the inept health care system and only adding fuel to the already out-of-control fire.

Of course, the health insurance issue is a complex one. Health insurance companies have taken control of how health is seen and treated in America. Prices are exorbitant because of a profit-at-all-costs mentality.  Now, the ballooning American health care system is viewed as grossly incompetent. Since money is the motivating factor for things to really change in this industry, it is up to the consumer to spend their money wisely. Consumers must put their money towards the things they want. By seeking out acupuncture for more of your conditions, consumers are voting for acupuncture to play a larger part in American health care.

Many acupuncturists believe that acupuncture can treat a wide variety of disorders and should not be limited.  You, the consumer, have already gotten acupuncture into the insurance companies’ collective mind.  The progress towards acceptance has begun to show on insurance policies.

Another thing that you, the consumer, can do is to ask your insurance company why some of your acupuncture treatments are not covered by them.  And keep asking.  If you want to see more acupuncturists accepting insurance, you must speak with your voice as well as with your dollars. When the insurance companies see where your money is going and hear what you want your insurance policy to cover, they will expand their coverage for more acupuncture-treatable conditions on their policies.  They will make it easier for acupuncturists to become an in-network provider and seamlessly support you, the customer.  You will start to have more health care options, more acupuncturists will begin to accept insurance, and you will feel better about the money you spend on your health care policy.

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