“It’s fine if you don’t want to take insurance/participate in Medicare, but don’t stand in my way. If you don’t want to participate you can make that choice.” — that’s the sort of thing practitioners pushing for insurance coverage of acupuncture lob at those who express reservations.
Although I personally believe third-party payer influence will be bad for our profession and our medicine, my greater concern is that most of those pushing for these changes have a limited understanding of how we will all be affected. If the profession as a whole understood what’s involved and still thought it was a good idea, I’d get off my soapbox. In the meantime, I’ll do my best to provide food for thought.
I have a client who is financially comfortable and she paid my fee for years without a second thought. At some point, her insurance began covering acupuncture. I collect full payment at the time of the treatment and provide a receipt which patients can submit for reimbursement if they choose. My typical treatment includes two sets of needles so I divide the payment into a 97810 and a 97811 code.
One day, though, I came into the treatment room after the first set of needles and there was that feeling of a great treatment. The room was peaceful, the patient was glowing, the pulses were balanced and lovely. Anything else I did would not make the treatment any better and most likely would make it worse. When I told the patient her pulses felt great she said, “I can tell.”
Before meeting her at the front desk, I spent some time struggling with her receipt. The treatment had still taken 50 minutes. But I hadn’t done two units of acupuncture, so I couldn’t use two codes. So, I used my 97810 code, and put the additional amount of the bill under other services, with no code.
This meant that the patient’s reimbursement was less than she expected, and she, of course, wanted to know why when she came for her next treatment. I explained that I had done only one unit of acupuncture instead of my usual two. The conversation then covered why I couldn’t bill for two units even if I had only done one (fraud), why I couldn’t have just done two units even if she didn’t really need it (also fraud, plus, not good for her), and why I charged her the same amount as usual if I had done less (I set my fee based on my time, not the number of needles). My client, who had never before questioned my treatment decisions and had been happy to pay my full fee before insurance gave her any reimbursement, was now an unhappy client.
Do I refuse to give any receipts to avoid this issue? Do I lower my rates if I do only one set of needles, even though, since I don’t know what will be needed in advance I still have to schedule the same amount of time?
Let me know what you think, but, here’s one thing I know. Don’t tell me that my practice won’t be impacted by your efforts to have insurance cover acupuncture.
© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2020. 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.