This is a common question with a not so simple answer. Hopefully, this information will help you get an accurate answer from your insurance provider.
There are a couple of cases where the answer is almost always YES:
- Were you recently in an automobile accident and haven’t used all of your Personal Injury Protection (PIP) coverage? Kentucky requires a minimum of $10,000in PIP for all auto insurance and this can be used for acupuncture, massage, and chiropractic in addition to other regular medical expenses. If so, we can bill your insurance or you pay cash and submit the receipts for reimbursement in most cases.
- Are you a federal employee who was injured on the job? If so, federal workman’s compensation coverage may include acupuncture. Contact us for more information.
- Are you an employee with an open workman’s compensation claim? If so, you may be able to get acupuncture coverage with a referral from your primary workman’s compensation doctor.
There are also cases you the answer just might be YES:
- Are you a federal or state employee? If yes, your plan may include acupuncture coverage.
- Are you a veteran under the care of the VA for a service-connected disability? We just might be able to get you a referral through the VA which will cover 100% of your approved treatments for acupuncture and massage.
- Are you an employee of a health insurance company? Many of these companies have plans that cover acupuncture for their employees even if they don’t provide it to their customers.
There are several cases where the answer will generally be NO:
- Tricare, Medicare, and Medicaid do not cover acupuncture and due to the abysmally low reimbursement rates, we do not accept any Medicare supplement plans at this time.
Do you have a Health Saving Account, Flex Spending Account or similar?
If so in most cases you can use these to pay for acupuncture.
In order to help make sure you get the coverage you pay for there are some additional questions you need to ask your insurance company:
- Do you cover acupuncture? ______________ If yes: Are there any specific diagnosis codes required for coverage or excluded from coverage? __________________________________It is important to get the ICD codes, not just condition name!!
- Do you cover CPT codes 97810, 97811, 97813, 97814? These are acupuncture specific codes- some insurance will say they cover acupuncture but in reality, they only cover the office visits and not the acupuncture itself.
- How many visits do you cover? ___________________
- Does my deductible have to be met prior to my coverage being effective?______________
- How much is my deductible and how far away am I from meeting it this year?____________
- Do you require an MD referral? _________________________________
- Some will say they only cover in-network providers or that they cover a higher percentage for in-network providers. Currently no insurance contracts with acupuncturists in the state of Kentucky so they are required to give you an exemption if you request it and treat us as if we were in network. It is not uncommon for them to “not be aware” of this but if you mention that you will “contact the state insurance board about their inability to provide an exemption” and they generally remember.
Do you bill my insurance?
With private insurance, we recommend you pay cash to get our Time of Service discount since most insurance covers a percentage of an allowed amount- which by law until they pay the bill they are not required to disclose (some do, some don’t). Since the allowed amount is often less than our billed amount and in some cases, even our time of service discounted amount you get the most money for your coverage by submitting your receipt to your insurance and letting them reimburse you for the amount they cover. By law, we cannot reduce our billed amount after the time of service and you will be responsible for any amount not covered by your insurance if we do the billing- even if that is more than you would have paid at our time of service.