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.