In 2012 when Pennsylvania rewrote their Essential Health Benefits list to determine what would be covered by most insurance policies, the state decided to default to a popular small business plan that did not include acupuncture coverage across the board.
However, some local plans do cover acupuncture, but often only for very specific conditions such as chronic migraines and cancer treatment support to help with the side effects of chemo and radiation therapy.
A popular alternative is to use a HSA (Health Savings Account) to pay for your care. Many employers now provide their employees with a Visa or Mastercard HSA debit card to cover copays and non-covered services such as acupuncture and massage therapy. Some people invest their own money into a private HSA for flexibility in care. We gladly accept HSA cards at Life Balance Acupuncture!
Always check with your insurer to see if you are covered for acupuncture treatments and if there are any specifics or limitations to your care. If you are covered and your practitioner does not bill directly, he or she can provide you with a superbill for you to send into your insurance company for reimbursement. We provide superbills if you do have acupuncture coverage!
While being accepted by insurance has its benefits, there are also some downsides to being an in-network provider. For instance, with the new health care laws in place, plans that used to fairly reimburse acupuncturists are now finding ways to reject their claims or pay them as low as $8 per treatment. This is frustrating as many acupuncturists charge affordable rates and provide exceptional and personalized care that is rare to encounter in our face paced healthcare model. Not many providers can make a living off these absurd reimbursements some insurers are now paying for their services and time.
On the bright side, a new law included with the ACA is Section 2706: Non-Discrimination in Healthcare. This provision states that health insurers must reimburse providers that are licensed in the state and are providing care under their state's scope of practice. This allows patients to choose if they would like to see an MD, an acupuncturist, a chiropractor, or a massage therapist. Click here to read the ins and outs, pros and cons of this provision in plain language.
This is helpful because in many states still, MDs that have MINIMAL (weekend) training in acupuncture and are allowed to perform it are covered and reimbursed, yet licensed acupuncturists (who are licensed under the state medical board and have over 2500 hours of diagnostic skills, Eastern and Western Medical theory and training, and needle safety and needling skills practice) are not reimbursed. This is a grave oversight and a huge disservice to patients seeking qualified practitioners.
To be fair, this is not to say that all MDs practicing acupuncture have not had adequate training.
Some MDs go through an entire 3-4 year acupuncture program and become L.Acs. Others continue their training to learn more about diagnosing from an Eastern perspective. Most are practicing "Medical Acupuncture" and it is quite different from traditional acupuncture.
It is always best to ask for your acupuncturist's credentials, licensure, and training based on your treatment needs and goals.
Over the next few years, acupuncture coverage in health insurance plans may become common place. However, do not disregard getting treated now because you may have to pay out of pocket.
Acupuncture is very effective and has helped millions of people heal on a deep level. It is worth your time and investment. In the long run, the money you will save on 'sick visits' to the doctor will pay for itself. Acupuncture keeps you well and is a wonderful form of preventative medicine for most people.
We hope you have a better understanding of the current issues and solutions facing patients and practitioners alike in the complex world of health insurance!