Frequently Asked Questions About Insurance for Acupuncture Treatment
1. Do you take insurance for acupuncture?
Yes, we do. Depending on your plan, we can either bill your insurance company directly or issue you a “superbill” that you will need to submit for reimbursement.
2. How do I know if Acupuncture is covered by my insurance?
The first thing to do is to call our office and provide all your insurance information so that we can verify your benefits. Another option is to call your insurance company and ask if your policy covers acupuncture for your condition.
3. Are you contracted with any insurance providers?
We are currently contracted as an In-Network provider for:
Santa Cruz Office Los Gatos Office
Landmark Healthcare Aetna
Aetna United Healthcare
Blue Shield PPO Blue Shield PPO
United Healthcare All other plans out of network in Los Gatos office
United Healthcare / Optum
Anthem Blue Cross Blue Shield
Premera Blue Cross
United Healthcare Signature Value
If you have an in-network plan our office requires an eligibility and benefits check at least 48 hours before your initial appointment. For in network plans you will be responsible for co-payment or coinsurance. For other insurance plans our office is considered as an “out of network” provider.
4. How much of my treatments will be covered by insurance?
Between 20-80% for most PPO’s. Herbs, supplements and non-acupuncture modalities (cupping, Gua Sha, massage) are typically not covered by insurance. If you have a Health Savings Account (HSA), then it will cover all of your treatment, and usually any herbs you may be prescribed.
In general Acupuncture services that are covered by your insurance include: acupuncture for pain management, nausea related to chemotherapy, and nausea related to pregnancy. Your insurance company may have certain limitations around your coverage. Usually acupuncture treatments for wellness care, fertility, ivf support and chronic conditions will not be covered, as the insurance industry (generally) does not consider these treatments medically necessary. This varies for each healthcare plan please feel free to contact my office for more details or to contact your insurance company for details on your policy and benefits. Your insurance coverage may be subject to co-payments, coinsurance and out of pocket costs as associated with your policy.
Please be advised that additional services may be recommended by Bridget Puchalsky L.Ac. including, but not limited to Chinese Herbal Therapy, Cupping, Guasha, Manual Therapy/ Asian Massage, Nutritional Consultation, Supplement Consultation these services (when not covered by your insurance) will be billed in an a la cart fashion for each treatment as provided. You will be advised of additional services and fees by your provider before treatment.
5. What is a Health Savings Account (HSA)?
A HSA is a tax-deductible health savings account which is set up by your employer. Usually you decide at the beginning of the year how much you think you are going to need for the year – this can include acupuncture, herbs, nutritional supplements, massage, whatever you choose – and then the amount comes off your pay check. The benefit of this system is that the amount you choose to deduct from your pay reduces your taxable income.
6. How do I use my HSA?
You will be given a special HSA credit card that works the same as any other credit card – give it to your health care provider at the time of treatment. You may also receive a checkbook that is linked to your HSA account.
7. How do I get reimbursement for my treatments when submitting a superbill?
The easiest way is to go to the website of your insurance provider (see the links below for a list of the most common providers). Print out the claim form. Fill it in and send it along with the superbill which my office will supply to you, then send the superbill to your insurance company directly.
8. Why am I being charged on my first visit to your clinic?
Despite our best efforts, sometimes an insurance company will say they cover acupuncture and even tell us a percentage, but then once we have billed we find out that the amount they deemed fair and reasonable was less than the cost of the treatment. For that reason, until we know what the insurance company actually covers for out of network plans, we ask that you pay the first treatment at the cash price.
Occasionally we will then bill the insurance company and reimburse you or credit your account as soon as we receive payment from them. As a small business we don’t like having to bill for money owed as much as you don’t like receiving a bill after the fact, so this way, we know it is covered. In the end ALL charges are the patient's ultimate responsibility if there is any lack of coverage from your insurance provider.
9. What is a superbill?
A superbill is a receipt of services that includes a diagnosis code and a practice code. It is used for patients to submit to insurance companies themselves for direct reimbursement.
10. Does Medicare or Medical cover acupuncture benefits?
Medicare no longer covers acupuncture benefits. Since Medicare does not cover acupuncture, Medicare supplemental insurances also do not cover acupuncture. If you have Medicare and a secondary policy, your secondary policy may cover acupuncture. Please contact your congress person or Medicare supplemental insurance and ask for coverage as the customer and demand in this case will determine change.