No Insurance Part 1 – The Insured
** This blog was written before FL Blue’s invitation to join their commercial network in Dec 2022. We have resumed to accept insurance on 3/15/2023. Your insurance will still need to be verified for coverage.
There are a lot of misunderstanding about insurance. Most people believe they are fine when they have insurance coverage, without knowing the details how things are covered (or not covered). Unless you pay a high premium, you are unlikely being covered by the insurance the way you wish. People typically buy insurance only knowing a few things about their plan as follows:
– Monthly premium (probably most important to many)
– Deductible
– Copay (most don’t understand co-insurance and think it is copay)
– General coverage areas such as hospital, ER, primary care visits, prescription
Some of you will go beyond the above and get to check if they can visit optometrist, chiropractor, massage etc.
When it comes to acupuncture, many plans will not cover it. Some will cover but make it almost impossible to use (by design). For example, a very high deductible has to be met before acupuncture benefit kicks in. We have seen plans that allows 10-12 acupuncture visits per year after a deductible of $3,500 (some plans has up to $6500 deductible) is met. This means you will either (1) have to see a lot of other doctors to fulfill your deductible before acupuncture benefit starts, or, (2) you use up all the 12 acupuncture visits only to find out your deductible is still not met. During the time you work towards the deductible, you are paying 100% of the contract rate. Your insurance company has zero financial responsibility.
This type of plans looks good on paper about coverage but it is only a sales gimmick.
Another type is some medicare advantage plans that you elect to pay more premium for more coverage by the managing insurance company (not from medicare), including acupuncture. These plans typically covers barebone acupuncture for 30 minutes. You barely have any time for the actual acupuncture after you are checked into the treatment room, get situated, being re-assessed by your doctor. The acupuncture needles have to be out before the 30 minutes lapses.
Finally, we want to discuss about medicare. This is correct that medicare has started cover acupuncture. However, there are some fine prints. First, they only cover “Chronic low back pain”. So, if you have neck pain, it will be an absolute “no”. Secondly, the acupuncture must be performed by an MD, APRN or PA who also has been to an accredited oriental medicine school, being trained and have a current active unrestricted license to practice acupuncture. We have not seen an MD, APRN or PA also graduated from an Oriental medicina school to practice acupuncture. So, we cannot provide acupuncture to medicare patients. We have callers arguing with us on this subject without the knowledge of the fine prints.
In conclusion, most patients are better off being self-funded. In this case, you have no restriction from the insurance company as what you can or cannot do.
