We’ll focus on some frequently asked questions that I receive from potential new patients. Do you accept insurance?
Currently in the state of Georgia it is not possible for an acupuncturist to get in network with an insurance company. In many other states acupuncture is routinely covered by insurance policies. Georgia is a little behind on certain things. However that is not the whole story.
Currently we receive payment at the time of treatment. My experience is that certain insurance companies are more likely to cover acupuncture than others. Best case scenario, if you have United Health or Cigna, it is well worthwhile for you to make the call to inquire. We ask that you look into this on your side as we are a small family owned and operated business and do not maintain a staff for billing as most medical doctors do. Other companies do have coverage but United Health and Cigna are most likely too. Some policies may cover 30-70%.
Tricks of the Trade:
We all know that the insurance companies job is to process your monthly payments (your fee for having the privilege of carrying their card in your wallet) and stamp “No” on as many as your submissions as possible. I realize it is not politically correct to say so, but this is the general consensus on the matter. If you are bold enough to make the phone call, you should know there will be “trials & tribulations”. So some useful information, that they would prefer you not have:
1. Call your insurance company and ask them if the cover acupuncture on your policy. If you get the “no” answer, try calling them back and ask if they accept claims for 97811 and 97810, low and behold, you may be quite surprised to get the “Yes” answer. These are the codes for acupuncture.
2. Ask them what you can use the acupuncture for. Let them answer the question. Most common is nausea and vomiting from chemo radiation therapy, nausea and vomiting from pregnancy, back pain, neck pain, and migraine headaches, etc. We have seen patients told that yes they have coverage, only to find out that after coming several times, they are told AFTER submitting your claims… “Oh sorry, your policy only covers “acupuncture in lieu of anesthesia” . Yes acupuncture is that good at treating pain!!!. Some folks may have religious reasons why they might not want to take anesthesia or be allergic to the medication and may opt for acupuncture during the surgery….that’s right completely awake, while your surgeon takes care of business.
3. We are out of network, and so they will want to reimburse you at out of network levels.
Now, we know its not your fault that there is no in network person for you to choose here in Georgia. There is something called “a Gap exception”, and each company calls it something different, its part of “the secret”. So what’s Gap all about? Its a means that you may petition your insurance company to reimburse you at the in network levels, when there is not a in network provider within a so many mile radius. Petition, as in they may say yes or no, but its worth the effort.
The Trials and Tribulations: Reality, if you have asked the right questions, and are told you will get reimbursed…then you will get reimbursed …you will have to work for it though….There is some inefficiency going on here whether intentional or otherwise. It may take you a month or two to get reimbursed and you may have to call several times. We have heard all the stories…, “Why Mrs. Smith its right here on my desk, I’m so sorry, I just don’t know why it hasn’t been processed.”
For patients who who seek reimbursement, we will provide you with “superbills” for your insurance company. Each week we get many exciting letters and phone calls from insurance companies…we immediately respond to them. Another tip, before you ask for a superbill receipt from us, ask your insurance company exactly what they want to see….this will save a lot of time…go figure there is no standard. Anything left out WILL delay your reimbursement.
What a Country! I love America and our glorious health-care system.
Call us with any additional questions you may have.
In good humor,
Mark Schwartz, L.Ac., FABORM, Dipl. O.M.