Acupuncture and Insurance

I keep hearing questions and complaints about insurance billing and acupuncture.  I don’t have an original post ready. This is adapted from an email exchange with some colleagues and thought it might be a good starting point for a conversation, despite the odd lack of context. But if you’ve been around for a while you can probably imagine what preceded it! (Then again, we should probably be out enjoying a holiday weekend rather than pondering our profession’s future.) —

“I am absolutely fine with practitioners pursuing all of the various business models that are available to us.  I want anyone who wants acupuncture to find a way to access it. Depending on both the practitioner and the patient, there may be certain models that are more appropriate or appealing than others.  Private room treatments at varying levels of cost with the money coming directly from the patient or indirectly via an insurance company, sliding scale models, in group or private settings, treatments as part of other medical care, I’m good with all of it.  I don’t believe that a patient’s willingness to make life changes is related to what they are paying for treatment. I don’t believe that lots of talk and time is necessary for people to benefit from treatment, though I believe it can have benefits.

“I do believe that lots of graduates come out of acupuncture programs with very little information about how to choose which model might be best for them or for the community in which they wish to work. I believe they often come out having been told some version of “if you build it they will come.” It makes me sad and angry when folks who invested so much in their education don’t have the business skills to make a go of it, especially when there are so many areas so underserved by LAcs.

“I don’t believe that fraud is necessary to make a living from an insurance based practice, and, I have seen many conversations about insurance billing for acupuncture that revolve around questionable practices. I certainly don’t think all practitioners engage in these practices, but some do. I also see practices that are by the book, but are still likely to have unconsidered consequences.  How many acupuncture treatments that are not billed to insurance involve three distinct sets of needle insertions, compared to those that are billed.  Does it take more sessions to treat back pain with acupuncture when the treatments are covered by insurance?  (Does the billing provider think of the treatments as being preventative once the back pain is in remission while the non-billing provider might not be thinking about back pain at all and instead pondering the client’s inability to relax even when on vacation?)  How do the answers to these questions impact data on the cost effectiveness of acupuncture?  As purchasers of health insurance, how do we feel if we think an MD is doing a more complicated procedure, with a higher reimbursement rate, than another, cheaper procedure that is equally effective?

“I did not mean to give the impression that offering a higher level of service when warranted will get a provider kicked out of a plan. However, if a provider’s patients consistently need a higher level of service that will get noticed by an insurance company. It may well be audited. And, it will be taken into account when the insurance company is deciding whether to continue to contract with a particular provider.  When you refer to this as an urban myth is it your position that insurance companies do not care whether a provider consistently bills for more services than other providers serving a similar population?”

Thoughts?

Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2018. Unauthorized use and/or duplication of this material without express written permission from Elaine Wolf Komarow is prohibited. Excerpts and links are encouraged, provided that full and clear credit is given with specific direction to the original content.

6 thoughts on “Acupuncture and Insurance

  1. It’s funny you mention this. In my state, we have very very few people with acupuncture as part of their coverage. Of course, the first question is always “do you take insurance?” I think people always feel a little cheated when their insurance doesn’t cover a healthcare procedure. I have been trying to make a list of reasons it is actually a positive for them not to have insurance involved in acupuncture. I may not change anyone’s mind but it gives me a more positive attitude going into the encounter.

    1) Patients deal with the acupuncturist directly, and in a timely fashion. Try calling a doctor’s office and see how long it takes to speak to the doctor or to get a call returned.
    2) Patients always know what the bill is. They will not be charged for lots of extraneous items. They will not think that insurance is going to cover your services and then receive a huge bill months later finding out they denied you coverage.
    3) Patients can shop around. They can actually call different offices and find out what the prices are. Again, try this with other medical providers.
    4) No gatekeepers or referrals necessary. You can receive treatment when you need it and not have to get a referral or prescription.
    5) You can be treated for more than one issue simultaneously.
    6) Short wait times, no waiting for months to see a specialist.
    7) Integrity. The acupuncturist knows you are paying good money to come there, and is motivated to deliver results in a short time. In clinics where insurance is paying the bill, the motivation is to maximize the number of visits or pad the bill. (Not accusing anyone specifically, but it happens).
    8) I can’t specifically prove this, but I hypothesize that a lot of the dissatisfaction with western medicine comes from the antagonistic relationship insurance companies foster between patients and doctors. Patients wonder if doctors are prescribing certain medications or ordering certain tests because insurance does or doesn’t cover it. Doctors can be short tempered, partially because they spend a lot of time hassling with insurance. Acupuncturists are known (at least to patients if not among ourselves) to be laid back, caring, and understanding individuals. I am certain this is more central to our success than anything else.
    9) We are one of the only healthcare profession to exist in the free market. Only the most high-end acupuncturist even approaches what a typical PT session costs. Most charge only a fraction of that. We are beholden to neither government nor corporate bureaucrats. This is something that I personally cherish and am proud of.

    • This is a great list.

      While I am so grateful that insurance is there to help people with truly unexpected/extreme medical events or people with truly limited resources, when it comes to day to day health maintenance it has encouraged an environment that can’t be sustained. “We” as consumers, want very good care (which takes time to deliver), we don’t want anyone to interfere with our choice of providers or treatments, and we don’t want to have to pay very much for the care we receive. We need the magical money printer to make that work.

    • Thank you Frank. Well written. I’m actually thinking of putting an article up on my website explaining why I don’t take insurance. So many of my patients have experienced a lack of care from the insurance end. Practitioners are under a lot of pressure to pump people in and out due to insurance billing. In fact NPR had an interesting segment – “Diagnosing: The Lost Art”. Insurance has changed the nature of health care. Clients don’t understand on some level the wonderful care we can give needs to be modified to fit the insurance/western model.

      Let’s face it, hypertension, fertility, diabetes and other complicated diseases require a lot of time in patient education, treatment and monitoring. Insurance will never pay for all of that. How can you treat infertility in 6 or 10 sessions? I can’t imagine insurance paying for long term treatment.

      Interesting enough: two practitioners in my area have been investigated for illegal billing.

      Is it right to use two sets of needles (to get more payment from insurance) when the client doesn’t need that? Does the insurance companies just see acupuncturists as technicians? If someone can treat with acupuncture and one set of needles, will we get the coverage?

      In the end, it’s a slippery slope which most Western practitioners appear to be very unhappy with. Is that our fate?

  2. I agree that these issues should be explored. I am annoyed because I was told by the leadership in California at that time that they were exloring those issues. That was fifteen years ago and we are still in the same position. I have little faith that they will do it. They are to disorganized as a profession. That is what I see maybe you know something I do not. I am always willing to have an open mind.

  3. I believe that the school’s do not provide enough information, support, internships, guidance and what ever else a student needs to be successful. I have been out of school for a long time but I have not heard that things have changed so much. In colleges they are providing so many services to students today. I do think this is an improvement and creates a model of sucess for the student. I am in school for OT and each year I have to do two internships of 140 hours a piece in two different settings. When I was doing acupuncture internship it was within the school with little influence outside that environment. I think it was a limited internship not about acupuncture but about our profession and options available to work.
    I see your point about keep acupuncture away from insurance and there guidelines. I do agree with your thinking. In my experience I was limited to the people who could pay for it. I wanted to treat more individuals. I am personally torn between the augments. I just wish our leadership would have formed more established guidelines of our practice a long time ago. These arguments were discussed thirteen years ago and doubt anything definitively will ever change. It is unfortunate.

    • Thanks for you thoughts. I’m right there with you about the lack of job preparation in most acupuncture schools.

      However, let me clarify that my point is not that we need to keep acupuncture away from insurance and its guidelines. In order to make acupuncture available to as many people as possible we probably need to use all the business models that are out there. My point is that participating in insurance has consequences for all of us, whether participating personally or not. As a profession we have not really explored these impacts. For example, the insurance model is a big reason why so much direct medical care is provided by Physician Assistants, Nurses, Nurse Practitioners, and various other medical extenders. There is not necessarily anything wrong with that — and, we hate it when anyone other than an LAc touches a needle. How will we deal with these competing pressures?

      These are issues we need to explore — though I’m hesitant to support the establishment of guidelines until I see a lot more thoughtfulness from those who would do the establishing.

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