Insurance and Acupuncture 2015- The State of the Profession

Many Acupuncturists hold that increasing insurance coverage is necessary for our professional future. It’s a main goal of the NGAOM. HR 3849 is the same legislation the AAAOM has lobbied for in the past. The Acupuncture and Oriental Medicine Society of Massachusetts is working on legislation mandating insurance coverage, and a similar bill has been introduced in Vermont. A handful of states include acupuncture in their ACA plans.

I don’t believe Acupuncturists have to sell their soul to participate with insurance, and I don’t believe insurance companies are evil.

I do believe many practitioners haven’t considered the overall impact of insurance coverage on their business, the profession, and the medicine.

Participating with insurance invites a third-party into the treatment room. The Acupuncturist (or any Care Provider), the Patient, and the Payer share one goal – that the Patient feel better as quickly as possible. Beyond that, there’s plenty they don’t share, including – how to define treatment success and fair compensation. How many and what type of treatments are necessary. What provider types to reimburse. How best to control health care spending. How to provide care for those with expensive medical conditions. How to assess quality care.

Patients and providers often see the payer (a faceless bureaucracy that isn’t in the treatment room) as the bad guy. But the payer’s business depends upon watching every penny, and always trying to get more for less. Payers often say no (or that’s too much) to patients and providers.

In the past year, conversations about insurance coverage have included:

  • Practitioners about to open their first practice with no idea where to begin.
  • Copies of statements from an Acupuncturist who bills insurance $2,000 per treatment.
  • A practitioner insisting that billing a Manual Therapy code for point location is legit.
  • Many responses of “everyone has pain somewhere, so bill for that” to questions about codes for a specific condition.
  • Discussions of how to use CPT codes so that reimbursement amount equals desired amount.
  • Concerns about audits.
  • Concern regarding reductions in reimbursement rates.
  • Complaints that panels are closed (the insurance company won’t accept additional practitioners in-network).
  • Reports that companies are requiring current NCCAOM credentials for participating providers, even when not required for state licensure.
  • Anger when offers of expedited payments for reduced amounts are offered.
  • Complaints about time spent resolving billing or reimbursement errors.
  • Questions about proper policies around co-payments and co-insurance.
  • Discussions of how to serve the patient who has not yet met their deductible.
  • Concerns about retaining patients who have reached their treatment limit.
  • Stated goals of treating patients with limited resources, without recognition that those patients often have limited coverage.

We’re inviting a powerful bureaucracy into our practices, one with the power to define our medicine in the eyes of the public. Other professions have strong and responsive support systems to balance the power of that bureaucracy. We don’t. Are we prepared for the continuing effort that will be necessary to protect our interests? We play this game at our peril.




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© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2033. 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.

3 thoughts on “Insurance and Acupuncture 2015- The State of the Profession

  1. medicare for all is on my mind a lot right now. I wish I had the link to the documentary I watched on Saturday pre-release. Our convoluted health insurance system is a factor to sending jobs overseas and makes it cost prohibitive for companies to want to open in America. I don’t want to dance with insurance companies. I want to eradicate them. Vote Bernie!

  2. The challenges facing the profession are massive and broad. Sadly, yet again many are looking for easy answers, thinking expanding insurance coverage is the one. In the over two decades of my practice I have seen this discussion come and go. The more non-practicing acupuncturists “lead” the profession, the more the topic comes up.
    While I am not opposed to accepting insurance as a matter of practice management choice, pushing for expansion or mandatory reimbursement is going down a path where there are clear winners and losers, and practitioners will mostly be losers. One only needs to look at the history of other professions, (especially chiropractic) to see how the story unfolds. The Acupuncture Education industry wins, because job opportunities will be more available (albeit at low salaries), so seats in schools get filled. From your post it seems like the NCCAOM wins yet again by certification being required in jurisdictions where it is not required for licensure. The insurance industry wins because they have another service to market, and another revenue stream to contribute to bloated CEO salaries. And, mostly practitioners lose. The patient base may expand, but fees/income will decrease. Working harder not smarter, is not a wise business principle. Overall the fees that insurance companies pay are lower than the fees the average practitioner charges. More importantly, the freedom to control fees is completely given up. Overhead continues to rise. The cost of needles, supplies, rent for those with offices, and every other business expense goes up. Over the last 15 years my own health insurance premium has gone up every single year, except for the years where I changed carriers and ended up with higher deductibles and lower benefits. I’d like to hear about one insurance company that has raised its reimbursement rate to practitioners every year, or even a few times over the last 15 years.
    The legislative risks are massive. Insurance is regulated at the state level. Every state has a powerful insurance lobby, while in most states acupuncturists barely have a legislative voice, if any at all. There are more regulatory questions than answers as coverage gets expanded. From fee limits, to scope of practice, to treating non covered patients, and patients whose insurance stopped covering a treatment, the list of problems that can arise grows.
    The only place that one can find the goal of the “payer hoping the patient gets better quickly”, is in the marketing department . In the boardroom, backroom, and claims department of every insurance company, the goal is to move a case off the liability column of the balance sheet as quickly and cheaply as possible. How the patient feels is of absolutely no concern.
    It is important to understand that an insurer’s sole interest, to the exclusion of all else, is generation of income and profit, and for publicly held companies to return income to investors. It is naïve to think otherwise. Is that evil? When it comes to the healthcare of Americans, some say yes. It is certainly extremely perilous to the profession.
    As my grandmother used to say, if you lay down with dogs and wake up with fleas, only you are to blame.

    • I was giving everyone the benefit of the doubt regarding the shared goal. The truth is, once in the system, Acupuncturists have are incentivized to not have the patient get better quickly. Or at least not report they are better quickly, because once they are better they no longer get to bill insurance. And continuing to use that knee pain code then skews the results for the effectiveness of acupuncture. Six visits later, everyone still had knee pain according to the reports.

      I was just thinking of an additional complication — the insurance companies typically cover pain codes. I’ll argue that, when it comes to quick and verifiable treatment of pain alone, pain looked at with small eyes, the average LAc is probably not the biggest bang for the buck when it comes to treatment. But, since that’s what the insurance companies cover, we’re going to stress that in the training, in the advertising, and meanwhile so many who could benefit from treatment for other things, who don’t have other good options – digestive disorders for example, they get neglected. In other words, if an LAc wants to pursue insurance, do they specialize in pain, or one of the many other wonderful things acupuncture can do.

      I agree, I’m for freedom of choice. If people want to pursue the insurance $ fine, but let’s be clear on how that impacts us all.

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