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Does My Insurance Cover Acupuncture?

Many insurance companies cover acupuncture now with some limitations.  Medicare does not currently cover acupuncture but there is a bill before Congress to have Medicare cover acupuncture. 


Depending upon your insurance carrier they will cover it with different criteria.  To best insure you can get reimbursed with the full benefits offered by your policy, here are a few questions to ask your provider. 


1)  Does my medical insurance policy cover acupuncture? 


2)  If not, is there a rider or add-on to my policy that will include acupuncture? 

Some insurance companies will cover acupuncture and other complementary modalities with a rider to your policy, even if you don't have it now.  Ask if it does and what the additional cost would be.  Depending on how many times you plan on going will determine whether this is the most cost-effective approach for you.

3)  How many treatments will my policy cover?   (The average is 20 treatments per year.)  

Knowing this allows you to plan; Do you want to go every 2 weeks for maintenance and dealing with chronic issues or is there an acute health crises, (infection/cold/flu, sprained ankle, recovery from surgery), that requires more frequent treatments for a short time?

4)  How much will my policy pay for an acupuncture treatment?

Costs covered vary and may not cover the full cost of the treatment or will require a co-pay.  Check so you will know what portion of the treatment cost will be reimbursed to you. 

5)  Are there any criteria I need to meet to insure that I am reimbursed?

Some companies want you to have a referral from your PCP.  It is often a good idea to mention that you are getting acupuncture to your PCP, even if insurance does not require it.  I often let my patients PCP know what I am treating if it would be helpful to their overall care and with the patients permission. 

6)  Do you limit your coverage to specific disease states or conditions?

Most insurance companies put a limit on the number of visits but not on the condition being treated but it is good to ask to be certain. 

7)  Does my acupuncturist need to be "In Network" or have certain credentials?

If the acupuncturist takes insurance then they usually need to be in network.  If you are submitting a Superbill to be reimbursed by your insurance company they don't usually need to be in the insurers network of providers.  Please keep in mind being in an insurance providers network is not an indication of the quality of acupuncturist; only that they have proven to the insurer that they have met state credentialing requirements and their license is in good standing. 

It is best to see a Licensed Acupuncturist, (LAc), because most states require that a Licensed Acupuncturist has met NCCAOM (National Certification Commission for Acupuncture & Oriental Medicine) criteria of attending a full-time 4 year Masters degree program of academic and clinical study, as well as passing several board exams and insurers know the LAc designation.

8)  If your desire for acupuncture treatment is based on an automobile accident, your auto policy may have medical costs covered in addition to standard coverage.  The medical costs add on to your auto insurance policy does not have visit limits, only an overall dollar limit you set at the time of getting your policy.  Check with your auto policy insurer if this is the case.  

9)  Inspired Acupuncture will gladly provide a Superbill with the appropriate codes for you to send to your insurance company for reimbursement.  


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