Acupuncture as an Essential Health Benefit

Starting in 2014, most health plans will be required to offer a comprehensive package of items and services to patients, known as “essential health benefits” (EHB). Under the new law, EHB must cover certain specific services including emergency services, maternity and newborn care, prescription drugs as well as preventive and wellness services, among others.

If you are a consumer or acupuncturist in support of acupuncture treatments being included as part of an EHB, you should send an email showing your support for acupuncture to:

Department of Human and Health Services:  EssentialHealthBenefits@cms.hhs.gov

The window of opportunity for you, the public, to voice your opinion to the government about how you feel is between now and January 31, 2012.  Act now!

Below is a link with some more information on acupuncture and EHB:

http://www.acupuncturetoday.com/mpacms/at/article.php?id=32458

 

 

Being Pushed Around the American Healthcare System

I’ve recently decided to look into accepting insurance patients at my office.  The reason behind doing so was not due to financial gain, as you will soon find out.  My main reason for signing up with an insurance company as a provider was to be able to share acupuncture and Traditional Chinese Medicine (TCM) with more individuals. My goal is to allow more patient access to the benefits of Eastern medicine and widen the acupuncture demographic profile.  But, my foray into being an “in-network” provider may be short-lived.  Please, read on.

There are still many people in the United States that don’t know about alternative healthcare and are completely in the dark when it comes to anything outside of Western medicine – “American style”.  I’m not trying to make a blanket statement for this country, but much of the general American populous wants a quick fix for their aches and troubles, and are willing to invest little more than waiting in line at the pharmacy to fill a drug prescription.  But, the main reason acupuncture hasn’t hit mainstream, is due to the fact that it isn’t yet part of the mainstream American medical model.  Most people will visit the doctors on their health insurance plan.  Even though some plans will cover acupuncture, quite a few acupuncturists will not participate as medical providers.  At the same time, insurance plans are eager to tout that they cover complementary care, yet the fine print reads that coverage is available only for a select few medical techniques and procedures. Lastly, the insurance plans are usually written to be so confusing, that many of the covered persons do not even begin to understand what medical coverage they currently pay for.

All of the HMO (Health Maintenance Organization) patients that have walked into my clinic are “last resorters”.  These are patients that have gone from physician to physician (for years) and have seen no positive results, and sometimes negative results from their healthcare.  All of the HMO patients that I’ve talked with were on some form of medication.  All of them were on at least 3 medications per day.  One patient was on 10 daily medications to help manage her condition.  (And yet, there was still no relief from her pain…which is why she was sitting in my office.)  These last resorters have been essentially circulated through the system, paying their co-pays, filling out mounds of paperwork, and spending time with their physician(s) and specialist(s).  Finally, one of the physicians or specialists waves the white flag at the patient’s confounding problem and passes said patient to “alternative” medicine, such as acupuncture.  Voila!  That very disappointed, extremely frustrated patient walks in my door.  Many times, this patient, distraught that the Western medical community couldn’t help them, is now looking for an Eastern medical miracle.

So, in front of me is today’s prospective HMO patient.  I inform them that there is a boatload of paperwork that they need to fill out.  I also tell the patient that I am only allowed to treat certain conditions under their insurance plan.  I am limited by the insurance company as to what conditions I will get reimbursed for.  (To sum up, the conditions generally accepted by insurance companies are pain, pain, and pain.) Then, I get to tell the patient that their insurance company also dictates how I can treat them.  Meaning, the insurance company decides what treatments I, the medical practitioner, can perform.  (I still don’t understand how the insurance company can possibly know what medical treatments are best for the patient.)  Lastly, if I haven’t yet scared off my possible new HMO patient, I get to tell them that the insurance company will only pay for a few minutes of my time.  My fee is capped by the insurance company and I won’t be reimbursed for anything more than approximately 30 minutes of time.  Any time spent with the patient after that WILL NOT BE PAID.

From my perspective, becoming an in-network healthcare provider, I can expect to severely discount my going rate for insurance patients.  I get to be limited in the types of treatments I can do.  This can lessen the overall effectiveness of the treatments, which can make my acupuncture and all of Chinese medicine look ineffective.  (We all know that humans have a tendency to relay a bad experience to more people than a good experience.)  Lastly, I have to keep tons of paperwork on each patient, and have to play phone tag with the insurance company to get paid if my paperwork is incorrectly filled out.

HMO’s are still available, but as you probably already know, there are a lot of healthcare providers that won’t accept HMO’s.  Why?  Because, for them, it isn’t worth their time.  Why would anyone fill their clinic with patients paying a severely discounted rate rather than their full-price counterparts?  Also, you may see a lot of new practitioners in their respective medical field accepting HMO patients.  Why?  Because these doctors are trying to build a medical practice and there are a lot of people with HMO’s that need medical care.  For the rookie doctor, seeing that HMO patient will pay off at least a tiny amount of their looming student loan.  Here’s yet another thing to think about.  And this one should really be chewed on for some time.  If a medical doctor sees an HMO patient and knows that 30 minutes is all that the insurance company will reimburse them, the doctor may only have time to diagnose a problem and give the patient a prescription.  (Pharmaceutical companies have drugs for just about every disease known.  Heck, they’ve even created some disease conditions so that they could develop drugs to treat them!)  Now, the doctor becomes nothing more than a drug pusher.  They know that too much time spent with the patient can cause them to lose money and business.  The doctor becomes bound by the hands of his insurance company.

To make a long story short, insurance companies have ruined the healthcare system.  Taking large profits, charging exorbitant amounts for insurance coverage, the insurance company giants have the financial clout to control the medical industry.  So much so, that medical providers are forced to change the way they provide medical treatments in order to make a decent living.  Patients are required to jump through hoops just to get the proper care they need.  As a healthcare provider, I’m torn between making acupuncture accessible to more people by way of insurance, and restricting my acupuncture care to those that can afford the out-of-pocket expense.  (I have bills to pay too!)  It’s still a tough decision for my clinic to make, since becoming an insurance provider indirectly feeds fuel to the already out-of-control health system fire.  There’s no easy answer to our healthcare mess. But one thing is for sure.  In the current American healthcare system, it seems that insurance companies are winning, and the care providers and patients are losing.

CA – California Pushing for Acupuncture to be Covered By Insurance

AB72.

Some of us acupuncturists treat patients on a cash only basis.  Others accept insurance.  Regardless, we all know that only certain insurance companies cover for acupuncture.  These insurance companies control the way medicine is used in the U.S.

Now, there is an effort being put together that is trying “to get every healthcare service plan, except a plan that enters exclusively into specialized health care service plan contracts, and every disability insurer issuing policies on a group wide basis, to provide acupuncture coverage under those terms and conditions as may be agreed upon by the parties.”

If you are in favor of such a plan, please contact Assemblyman Mike Eng to find out what you can do to support it.
Note that there are pros and cons to this bill.  Understand what you are voting for before doing so.  But, also understand that doing nothing only does nothing for the acupuncture community.

Read more about it here:

http://news.xinhuanet.com/english2010/health/2011-02/26/c_13750970.htm

http://www.aroundthecapitol.com/Bills/AB_72/20112012/

http://democrats.assembly.ca.gov/members/a49/

Wikipedia Proves Acupuncture is Mere Smoke and Mirrors!

I’ve recently become aware of the *ahem* un-biased opinion of acupuncture according to Wikipedia.  It seems as though the writer has exercised some leniency with his/her objective “findings”.

Since I’m an acupuncturist, you can assume that I am a non-biased party.  Although I try to be as unbiased as possible when it comes to medicine, not everything can be put “on a scale of 1-10, with 10 being the worst…” as Western medicine must try to quantify…with everything. It makes life a series of 1’s and 0’s…you know, very “scientific”.

So, let’s break down some of the ideas in Wikipedia:

1.  The idea that evidence based medicine is superior to any other form of medicine.  Well, it isn’t.  Just because there is evidence to prove something is valid, does not make it worthwhile.  Let me chime in here with a list of pharmaceuticals that were approved for sale using “evidence based medicine” and later pulled off the market for maiming and killing people (all in the name of corporate profiteering):  Paxil, Vioxx, Fen-Phen to name just a few.  To see more, visit http://www.drugrecalls.com or visit http://www.recalls.gov.  There’s a special section just for medicine, and I’m pretty sure it’s not about acupuncture.

Isn’t the hippocratic oath taken by doctors swearing to practice medicine ethically?  Obviously, someone didn’t wikipedia that one. I digress.

2.  Yin, yang, qi sounds like a whole lot of smoke.  I can’t believe that the ancient Chinese could not have realized that they were using the wrong medical terms at the time!  Trying to explain and name things that could not be seen with the naked eye is not a downfall.  They were trying to advance medicine.  Even today with the highest power electron microscopes, there are still things that exist which we cannot see.  And today we do it to try and advance medicine.  It’s a continuum.  How can the pot call the 2000 year-old kettle black?

3.  This one’s a good line from the Wikipedia…”Acupuncture was developed prior to the science of human anatomy and the cell theory upon which the science of biology is based”.  Um, well, the science of human anatomy and cell theory may explain a little bit of medicine now.  So, how come the great “science of human anatomy and cell theory” hasn’t figured out the mysteries of the human body?  I’ll tell you.  It’s because it’s flawed.  Every medicine that is practiced today has flaws.  This is why we need all forms of medicine to continue to be practiced, lest we lose some simple knowledge of the past in hopes that we’ve come so far as to not need it anymore.

So, I know I’m preaching to the choir about this, because people who don’t believe in alternative medicine probably won’t be looking at my blog for information.  Usually I will see them in my office when they’ve exhausted all of the treatments that Western medicine provides and they are at the end of their rope and are looking for a miracle.  And suddenly, they believe in acupuncture.

Oh, there will be more from my little brain soon…Right now, it’s on fire!  Oh yeah, can someone with an actual acupuncture background rewrite the Wikipedia link on acupuncture?  Please?

Dry Mouth, Dry Eyes, Ugh! Could Acupuncture Provide Relief? Yes!

I’ve recently been introduced to what I will call a xero-xero patient.  This is a patient that suffers from xerostomia, or dryness of the mouth and xeropthalmia, or dryness of the eyes.  Sometimes diagnosed as Sjogren’s syndrome, the disease is a hypofunction of the salivary and lacrimal glands.  But, please note that Sjogren’s syndrome is a systemic autoimmune disease that may affect other organs, some of which are kidney, liver, stomach.  The distinction here is that the xero-xero patient that I am discussing here may or may not have clinically diagnosed Sjogren’s syndrome.

There are many sufferers of chronic dry eyes and dry mouth (DEDM). Those that have been diagnosed as Sjogren’s amount to approximately 4 million with about 9 out of 10 being women. There are probably many more people that are undiagnosed and may suffer some degree of subclinical DEDM.

Some of the causes of DEDM are (surprise!) medications, autoimmune disorders, radiation therapy, along with head and neck cancers. So far, there is no Western medical cure for DEDM.

Usually as a last resort, many xero-xero sufferers turn to alternative medicine to see if any relief can be found. One such modality, acupuncture, and namely ear acupuncture has produced some surprising results.

A study done by Peter Johnstone, Richard Niemtzow, and Robert Riffenburgh has shown that xero-xero patients may find relief through acupuncture.  They have developed a protocol using 6 points on the ears and 2 points on the index fingers to treat this debilitating disorder. It requires ear needles and sugar-free lozenges to help stimulate and maintain saliva production.

I treated my xero-xero patient today, following the instructions provided in the protocol.  Within 10 minutes of the initiation of treatment, the 85 year old woman began to have a frothy salivation, which continued throughout the remainder of the treatment period (of approximately 40 minutes).Having no prior knowledge of this protocol, I was able to produce some successful results the very first time.  I’m not saying that this is a cure for all sufferers, but that many will find some degree of relief.

The main reason why I am blogging about this, is because I want this treatment protocol to be in the knowledgebase of the acupuncturists practicing in America today. It hasn’t seen widespread use and more knowledge and practice of this protocol will help us all understand the mechanism behind the treatment. So, gather up your patients with Sjogren’s syndrome, head and neck cancer, chemotherapy, radiation therapy or just plain dryness in the eyes and mouth.  Treat them with this protocol and add another tool to your acupuncture toolbelt.

The links follow:

http://www.n5ev.com/Dry%20mouth%20and%20dry%20eyes%20acupuncture%20technique%20update%20Oct%2015,%202009.pdf

http://www.n5ev.com/xerophthalmia.pdf

Product Recall of Triad Group Alcohol-Based Prep Pads, Swabs, and Swabsticks

Triad Group, a manufacturer of over-the-counter products has initiated a voluntary product recall involving ALL LOTS of ALCOHOL PREP PADS, ALCOHOL SWABS, and ALCOHOL SWABSTICKS manufactured by Triad Group but which are private labeled for many accounts to the consumer level. This recall involves those products marked as STERILE as well as non-sterile products. This recall has been initiated due to concerns from a customer about potential contamination of the products with an objectionable organism, namely Bacillus cereus. We are, out of an abundance of caution, recalling these lots to ensure that we are not the source of these contamination issues.

Use of contaminated Alcohol Prep Pads, Alcohol Swabs or Alcohol Swabsticks could lead to life-threatening infections, especially in at risk populations, including immune suppressed and surgical patients. To date we have received one report of a non-life-threatening skin infection.

Alcohol Prep Pads, Alcohol Swabs and Alcohol Swabsticks are used to disinfect prior to an injection. They were distributed nationwide to retail pharmacies and are packaged in individual packets and sold in retail pharmacies in a box of 100 packets. The affected Alcohol Prep Pads, Alcohol Swabs and Alcohol Swabsticks can be identified by either “Triad Group,” listed as the manufacturer, or the products are manufactured for a third party and use the names listed below in their packaging:

Cardinal Health
PSS Select
VersaPro
Boca/ Ultilet
Moore Medical
Walgreens
CVS
Conzellin

Please visit http://www.fda.gov/ MedWatch/report.htm for more information on product returns and refunds.

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.

Curious About Whether Your Insurance Covers Acupuncture Treatments?

Consumers are still learning about whether or not acupuncture is covered under their insurance plan.  Of course, the insurance coverage game is always changing, so please check with your insurance provider for the most up-to-date information.

Here’s a great webpage that answers some of the concerns of the average consumer that may be looking for their acupuncture visits to be covered through their insurance.

http://altmedicine.about.com/od/alternativemedicinebasics/a/Insurance.htm

US – Why L.Ac.’s Need to Support an Acupuncture Organization

Hear ye, all L.Ac.’s!  I’m calling out to each and every one of you!  I say, to acupuncture practitioners, teachers, students, researchers and anyone that cares about keeping acupuncture as a profession.  We need to push acupuncture forward to capture the eyes, ears, and minds of the medical industry.  We need to organize ourselves!

I know the demographic of people who usually enter acupuncture school, is one of strong desire to practice a more natural form of medicine.  It is a demographic that is bent on a strong sense of individualism.  You are the type of person that wants to run your own practice.  You want to do things your way.  You don’t want to have to cut through a lot of legal red tape and statutory demands that seem to bog down other medical professions.  You want to help heal people and that is your main focus.

I know who you are.  You are just like me.  We are one and the same, L.Ac., but we don’t act like it.  After school is over, and graduation is behind us, we scamper off, eager to build our own individual acupuncture operation.  We want to work at our passion in sharing everything about alternative medicine.  And, it is not until some law or regulation that binds our feet in practice, do we raise our hands in disbelief, and raise our voice in question.

The problem is that one voice may be loud enough to fall on a few ears, but that voice fades quickly.  One voice does not carry very far.  Two voices, though, can be heard more strongly, and three voices even more so.  With enough voices, we as a profession can be heard loud and clear all the way to the state Capitol building, and maybe even on to the Hill.

To be heard, we need to assemble ourselves and band together.  By uniting, we as a profession become a stronger voice, a stronger force.

At this point, there are many organizations that are trying to band licensed acupuncturists together.  They are trying to create a synergistic body, one that is greater than the sum of its individual parts.  They want our voices to be heard in the judicial halls of the city, state, and country, because that is where your acupuncture legislation is stamped for approval.

These organizations are pushing for your ideas, your laws, your future in the profession of acupuncture in the United States.  So, I ask you to support them in their effort.  Because their effort is what is creating your occupation.  Join something.  Join anything.  Support your acupuncture profession with your words, with your voice, with your heart, and if you can, support with your wallet.

Because without these acupuncture organizations, you don’t exist.

CA – Push For All Practicing Acupuncturists To Have Fingerprints on File Beginning in 2011

For those licenses expiring on or after January 1, 2011, the Acupuncture Board will require licensed acupuncturists that were licensed prior to January 1, 2001 or for whom a record of the submission of fingerprint no longer exists, to submit a complete set of fingerprints to the California Department of Justice (DOJ) as a condition of license renewal. See Title 16, California Code of Regulations, section 1399.419.2.

http://www.acupuncture.ca.gov/pubs_forms/fp_renew_req.pdf

For all of the licensees that have already given fingerprints for California licensure, there is no need to do anything else.