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Accupuncture and Health Insurance Coverage

With the rise in patients seeking acupuncture as a viable pathway to optimal health, many group health insurance plans now offer coverage for alternative therapies.

Acupuncture, previously considered by some as Eastern quackery, has proved itself to be a growing trend for patients looking for alternative ways to resolve medical conditions unsuccessfully treated by the mainstream medical community.

As a result of increasing demand from health group members for alternative care coverage, group health insurance companies such as Oxford, Premera and Aetna provide varying degrees of alternative care coverage. The amount of coverage depends on each individual plan.

Group Health Care Plans Response to Acupuncture

In Washington State, for example, several health insurance plans offer full coverage for acupuncture services. Companies like Premera through their Blue Cross, Basic Health, Health Plus and Lifewise group health insurance plans provide coverage for acupuncture visits, subject to the policy co-pay. Be advised, however, that some group heath plans limit acupuncture benefits to specific conditions. It is strongly recommended to call the insurance company before seeking treatment.

Similarly, Oxford Group health plan policies that are endorsed with the “Alternative Medicine Rider” provide coverage for acupuncture services. There are, however, further stipulations as to the type of acupuncture care covered. For example, Oxford will not reimburse policyholders for acupuncture used for weight loss, smoking cessation and continued, ongoing care for general improved health. Ongoing acupuncture treatment must have a clearly defined and achievable goal.

Not all group health insurance providers are as confident in the scientific benefits of acupuncture, and therefore limit coverage for this alternative therapy. Aetna’s group health plans, for example limits it’s acupuncture coverage to instances where patients use acupuncture instead of an anesthesia.

Pertinent Questions to Ask an Insurance Provider

Individuals who regularly use acupuncture as a method of treatment should spend a little time asking questions of their health care provider. Unfortunately, people spend more questioning a car salesman prior to purchasing a car than they do finding out about alternative coverage under their group health plan.

Anyone looking to pay for acupuncture treatments via a group health insurance plan should ask the following questions of their insurer.

How many treatments does the policy pay for?

The ideal and rare group health plan offers unlimited acupuncture treatments. More often than not, insurance companies allow anywhere from 12 to 35 treatments a year. More restrictive policies limit treatment to a maximum of 12 visits a year.

Is the limit for acupuncture shared with other alternative therapies?

Determine if the acupuncture visit limitation is applied to acupuncture visits only or is it a blanket limit applying to chiropractic, message and other types of alternative care.

Is coverage limited to in-network acupuncturists only?

Most group health insurance plans require patients to visit doctors located within the network or run the risk of paying large out of pocket expenses. Before visiting a new acupuncturist, check to ensure that she is included in the insurance plan’s network.

How are deductibles and co-pays applied?

It is important to find out if acupuncture visits are subject to a policy co-pay or if the plan is subject to a policy deductible before it will cover visits. If acupuncture visits are subject to a deductible, patients can conceivably pay $500 and up of out of pocket expenses before getting reimbursed. Patients should be aware of this information prior to visiting the acupuncturist.

Group health insurance plans have come a long way to accommodate the requests of their members. While not all plans cover alternative therapies, members have a growing selection of plans to choose from to cover their alternative care needs.

About the author: Felicia A. Williams is a former insurance broker who is now a freelance writer.

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