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Does my Insurance Cover Acupuncture?

November 1st marked the beginning of open enrollment for the Health Insurance Market Place.   This is the time when consumers are encouraged to evaluate their health insurance policies and decide if there is a plan that their existing insurer offers that best suits their needs or if there is another insurer that has something better to offer.  It also marks the time that health insurance companies are required to accept applicants without regard to health history.  Every insurance company offers multiple insurance benefit packages.  There are so many options that it can be dizzying to come to a decision–especially when you have to compare the services provided with each plan, co-insurance costs, copay costs and the total out of pocket costs.  For the past 10 years the CAC has been committed to identifying and engaging insurance companies that offer acupuncture benefits, so that our patients can use their insurance benefits to cover acupuncture treatment.

 

We have been successful at becoming preferred providers for one large employer and one medium size employer in WNC that offer acupuncture benefits to their employees.  These companies are Mission Health Services and Warren Wilson College.  For these employees we are able to file claims with their insurance company as in-network providers.

 

We became members of the Veterans Choice Program in 2016.  This allows Veterans to receive acupuncture through their VA health benefits when they have a referral from their VA physician.  We have been able to help dozens of Veterans get relief from pain, PTSD, and other medical issues over the past year through the Veterans Choice Program.

 

We have also been able to help many other patients get reimbursement for their acupuncture benefits.  These patients have insurance with acupuncture benefits, but we are not contracted as in-network providers with these companies.  In this scenario, patients pay at the time of service and then get reimbursed by the insurance company or have the charges applied to their annual deductible.  These insurance policies include Federal Blue Cross Blue Shield (BCBS), and several out of state BCBS policies including Texas, Illinois, California, New York, Oregon, Washington, and Maryland.  We have seen some United Health plans with acupuncture benefits, Mail Handlers Benefits, and Medcost.

 

The 2016 list of plans that we have found that offer acupuncture benefits is too extensive to list here, but we will list the companies that we found cover acupuncture in a separate blog post.  The good news is that acupuncture is increasingly becoming a standard benefit that is offered with health insurance policies.  There are five states that have declared acupuncture as an essential health care benefit: California, New Mexico, Alaska, Maryland, and Washington.

 

Unfortunately, we have not seen any BCBS of NC policies that are offered on the exchange in North Carolina that have acupuncture included as a benefit.  Medicare and Medicaid also do not cover acupuncture.  However, for those with Medicare and a secondary supplemental insurance, sometimes the secondary insurance does cover acupuncture.  The bottom line is you have to check with the insurer and inquire to find out if acupuncture is covered and if so what restrictions may apply.

 

There are essentially four options for purchasing an insurance policy;

  1. purchase one through the exchange,
  2. through your employer,
  3. directly from the insurance company

If you decide on a Bronze level plan make sure it is a HSA plan (Health Savings Account).  Money that is contributed to your HSA account can be used to pay for acupuncture treatment. This is true for all HSA health insurance policies.

 

An option that is not health insurance is called health care cost sharing. Many people have not heard of health cost sharing.  These cooperative health care cost organizations are similar to insurance, but are not insurance.  With a health sharing account you are free to see any provider you choose.  The administrators determine if the services provided are eligible for cost sharing based on the membership agreement.  Being a member of a health sharing organization exempts you from the tax penalty of not having insurance.

 

 

The health cost sharing plan that I am familiar with is Liberty Health Share.  Switching to this plan from the United Healthcare insurance policy I purchased for our family OF FOUR saved us more than $450 a month in premiums, and reduced our annual deductible from $12,000 to $1,500.  However, there are some caveats.  A health cost sharing plan may be more appropriate for healthy individuals or families that have no pre-existing conditions.  Pre-existing conditions are not covered for the first 3 years of membership.  The health cost sharing plans I have seen are administered by Christian ministries. As a member you agree to live a healthy lifestyle, which in turn will keep down the cost of healthcare costs for members. If there is a history or a current issue with alcohol, tobacco or other substance abuse this could prevent you from being able to join the group or could negate cost sharing of medical expenses that are related to these health issues.  The final caveat is that mental health services are not covered.

 

In the future we hope to see more states recognize the asset that acupuncture is to our health care system and pass legislation that categorizes the service as an essential health care benefit.  In the meantime, we will continue to work to get BCBS of NC to recognize acupuncture and Licensed Acupuncturists as an important part of our community health care system.  We also plan expanding our preferred providers status with additional insurers in order to create a partnership that benefits both our patients and our employees.

 

We hope this information helps you and encourages you to closely evaluate your health care choices for 2017.

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JOSHUA HERR   / MS, L.Ac. Dipl. Ac. & C.H. (NCCAOM)

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