In an effort to avoid addiction from over-prescribing opioids in the medical community for chronic pain there was an effort made to include acupuncture as a covered therapy under medicare. In order to do so, evidence was needed to prove acupuncture is effective.
A couple of years ago a study was conducted using acupuncture to treat chronic low back pain. Interestingly, the study was terminated early because acupuncture treatment was shown to be a successful therapy. Acupuncture officially became a therapy covered by medicare insurance.
Here’s how it is limited and dysfunctional as an insurance coverage for acupuncture…
Only providers within the medicare system can perform acupuncture if they have the proper educational background. Acupuncturists are NOT providers in the medicare system. Unlike other commercial insurance providers, acupuncturists cannot request to become a provider for medicare insurance overseen by the federal government. This will take an act of congress to change the laws governing medicare. Good luck with waiting for congress to act!
Oh, it gets even more nonsensical…
Keep in mind, the original study was a limited test for low back pain so, if you have any other pain located in any other area of the body, coverage will be denied.
Acupuncture has shown to be effective in so many different types of health conditions beyond pain. In my clinical practice I specialize in not only all types of chronic pain but also digestive disorders, mental-emotional imbalances like anxiety, depression and supportive therapies for hormonal imbalances.
There are some exceptions where folks with medicare insurance are being serviced through commercial insurance companies like Blue Cross Blue Shield or United Health that will cover acupuncture by an acupuncturist if the acupuncturist is in network with the insurance company. Even with this exception insurance coverage for acupuncture therapy will still be limited to low back pain.
So if you are wondering if you have coverage for acupuncture you can call your insurance provider and ask 3 questions:
- Do I have insurance coverage for acupuncture?
- Are licensed acupuncturists considered providers who can submit claims for acupuncture services?
- Does my insurance plan limit the type of medical condition my insurance covers, for example is my insurance plan limited to only covering low back pain?
Or
We can HELP verify your medical insurance! It’s simple!
If you find you do have limited insurance coverage for acupuncture, you can contact your insurance to make changes to your insurance coverage. Ask for “Routine Acupuncture” coverage to be added to your plan.
Since medicare began to offer what I call dysfunctional acupuncture coverage, there are 2 types of acupuncture coverage to know:
1. Routine acupuncture insurance coverage – covers a wider variety of medical conditions and acupuncturists are considered providers in network.
2. Medicare-based acupuncture insurance coverage – only for low back pain and acupuncturists are NOT considered providers in network and therefore cannot submit claims for treatment.
If you are interested in our acupuncture clinic services and you need help verifying your medical insurance you can fill out our secure, friendly online form from our website by clicking this link to Verify Your Insurance – https://natureshealing.info/#verify
UPDATE 10-20-2022: If your insurance plan offers both routine acupuncture and medicare-based acupuncture please note an acupuncturist will not be able to submit claims for a diagnosis of low back pain under the current dysfunctional system. This type of plan is driven by the diagnosis. If the claim is for low back pain it will be directed toward the medicare-based insurance coverage and again because acupuncturists are not considered providers in medicare it will deny the claim. Calling your insurance company to bring awareness to this important matter can be helpful.
