Navigating Acupuncture with Medicare and Supplemental Insurance: What You Need to Know

The most commonly asked question I get in my practice is. Do you take Medicare?

The legislation has evolved over the past four years, and insurance companies have changed their plans accordingly, so here are some details to help you navigate it. 

 I am based in Portland, OR, but the fact might vary considerably if your plans are based in a different state. 

Let me clear up some misconceptions. 

 In my previous post, I wrote that 12 acupuncture sessions will be covered for Medicare patients. That was our assumption. Well, it is, but there is a hook. 

 It is covered  ONLY  when your acupuncturist is an MD or LAC who practices under the supervision of an MD. What do I mean by that? 

For your acupuncture treatments to be covered under your Medicare insurance, they must have been provided by or supervised by an MD. I know this is scarce. 

 In Oregon, most acupuncturists are likely in solo practice and  LAC. In the last four years, we have painfully discovered that if we provide those services and are not under the supervision of an MD, we will not get paid. 

 That is the reason why when you are wondering why acupuncturists do not accept Medicare patients. 

 The second possibility is having supplemental insurance, which gives you power when you can take action and be an educated consumer.

 You want to find your practitioner, check if they accept new patients, call the number on the back of your  insurance card, and ask the following questions:

1/

 Is acupuncture covered under your plan? An effective date of coverage from ---to.----

2/

 Is acupuncture covered if provided by XYZ, a licensed acupuncturist?

You want to call with the acupuncturist's name in mind and find out if they are in the network. Also, check if the plan excludes paying MDs who provide acupuncture only. I can not stress how important this is.

3/

/ Do you have a deductible? Is there a separate deductible for alternative healthcare? 

/ I have seen this in some Regence plans. /

 Has it been met? 

4/

 What is your copay?

5/ 

Is there a limitation to the diagnostic code covered?

/ This is when you find out on page 20 of your manual that there is only one condition that is covered; you want to know that information /

6/

 How many treatments are covered? Some plans cap the number of treatments, and some cap the amount of money. The most likely cap is 12 treatments of years/ $1000 dollars.

7/ 

Is there a pre authorization number I need? How many treatments does the preauthorization cover

/ It is usually 3-4 treatments./

8/What is the calendar year for your plan? 

/ Very important some plan starts 7/1/

 With this information, you can email your acupuncturist and tell them all the info you have. 

 You will likely have a $20 copay and 12 txt a year and be ready to go. 

 I hope that helps. 

 Good luck