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Understanding Insurance Benefits

While most clinics would love to be able to provide access to all patients at an affordable price, the cost-of-living often prohibits clinics from offering payments on a sliding-scale. Fortunately, many insurance plans do offer acupuncture benefits, making acupuncture more accessible as a treatment option.

As more plans are covering acupuncture, and more people are seeking acupuncture treatments, one of the most common questions we hear is, "Do you accept my insurance?"

Well, that depends.

First question we need to know is whether or not your specific plan has acupuncture benefits. This comes even before knowing whether we are in or out-of-network with your plan.

There are two main ways to find out if you have acupuncture benefits: 1) Call your insurance and ask to speak with a Representative. 2) Check your benefits online via your subscriber portal.

Of course, you can always give our office a call and ask us to verify your acupuncture or plan benefits for you. Sometimes this will lead to the most accurate and clear results, as there a couple of important pieces of information that we need to know:

  1. Does your plan cover acupuncture?

  2. If so, what are the benefits?

  3. How many treatments or sessions does the plan cover?

  4. Is the benefit subject to a deductible? If so, what is the in and out-of-network deductible?

  5. Is there a copay or co-insurance?

  6. Are there any additional details or limitations?

Once we figure out if your plan covers acupuncture, and what those specific benefits are, we then determine what you would be responsible for by assessing whether we are in or out-of-network with your plan.

Again, it's important to get all of this information before booking an appointment, so that you do not end up surprised. Not all plans have acupuncture coverage. Some that do may be subject to a high deductible having to be met before coverage kicks in. Others may have acupuncture coverage, but "only in lieu of anesthesia." This essentially means you do no have any coverage!

Often having a copay makes it quite simple; the amount due is the same throughout the year. However, if you have a coinsurance, this means that your treatment coverage is subject to a deductible being met before insurance will kick-in and cover some of the costs. This is super important when your insurance calendar plan starts over; for most, this will be January 1st each year.

At the start of a new insurance year, your deductible starts all over again. Of course, your visit limit starts over again as well!

With that said, if you have acupuncture benefits and they are subject to a deductible, it is often advised to use all of your sessions before the next calendar year starts. This way, you can maximize your benefits without overtaxing your wallet!

By the same token, if you have a Flexible Spending Account (FSA), this can be used towards acupuncture services - whether you have acupuncture benefits or not. With a FSA, any extra dollars you have in your account do not roll over at the start of the calendar year. Just like the visits you have, you either use it or lose it!

While figuring out insurance coverage can seem quite complicated, we are here to help simplify the process for you. Often calling with your insurance information at the scheduling of an appointment can allow us to help you verify your benefits.

In the meantime, if you have any visits left or money in your FSA, know is the time to use it before January 1st comes!

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