“The insurance company used to pay this code, now they won’t, what can I do?” or “Why are they asking for preauthorization all of a sudden?” Questions like this have suddenly become common in acupuncture discussion groups. I believe that until recently, most insurance companies in most jurisdictions saw a relatively tiny number of claims related to acupuncture services. Now, as more practitioners and patients take advantage of increasing coverage for acupuncture, we’ve crossed a threshold. Some companies now pay out enough for acupuncture services that it has become worth their while to pay closer attention to claims.
Given the cost of conventional medical care (greatly related to technology and Big Pharma) insurance makes sense. It is easy to imagine circumstances, and many of us don’t have to imagine, in which one could owe tens or hundreds of thousands of dollars for medical care. That isn’t the case with acupuncture.
It’s great if you’ve decided that part of your practice will be working with insurance. It is nice that we have the option. For some it signals that “we’ve arrived.” It helps our acceptance and it enables us to reach a population that might not otherwise consider our medicine. Currently, acupuncturists who know how to work well with the insurance system may do well with their reimbursements, coming close to matching their regular fee.
Please, though, be aware. The more your income is controlled by the insurance companies the less control you have . And the more our profession depends upon insurance the more power that industry has over our medicine. If the industry decides to cut reimbursements, or to further limit the codes they will cover, or the number of treatments they’ll cover (and if we look at the experience of other professions we know they almost certainly will) we may find ourselves stuck. If the insurance industry determines they will only cover acupuncture for back pain will that influence even those paying out of pocket?
Some practitioners are not working well with the system but are instead working the system — billing for more units of acupuncture than they perform; adding additional services to the treatment, or even worse, just to the bill; using ICD codes that get reimbursement even if that isn’t the focus of treatment. They sometimes cross the line into fraud, though they believe they have good justifications for doing so. Big Insurance is unlikely to agree, and that will reflect upon all of us.
Personally, I’ve made the choice to discount my fee directly to my clients. I find it much more enjoyable than getting the same amount only after a painful dance with the insurance industry. It’s great if you make a different choice. But don’t forget that with greater participation comes greater scrutiny. When you play with the insurance companies, they set the rules, and they can always find a way to win, even when playing with professions far more powerful than ours.