How to Get Acupuncture Covered by Insurance

The question on many people’s minds is, “How to get acupuncture covered by insurance?” Acupuncture is a centuries-old holistic healing practice that has gained popularity in recent years for its effectiveness in managing various health conditions. Whether you’re seeking acupuncture treatment for pain relief, stress reduction, or to improve your overall well-being, the financial aspect can be a concern. 

In this article, we’ll explore the steps to make it possible for you to get your acupuncture treatments covered by your insurance provider. Let’s begin!

Is Acupuncture Covered by Insurance?

More health insurance plans now cover acupuncture, including some state government insurance programs, to treat chronic pain and various other conditions. However, the scope of coverage can vary significantly depending on the specific insurance program. In the case of government-run insurance programs, the Department of Veterans Affairs (VA) and Medicare provide coverage for acupuncture, but the conditions and guidelines for coverage differ.

VA (Department of Veterans Affairs)

The VA provides coverage for acupuncture as part of its Whole Health System of care. Acupuncture is considered a complementary and integrative health (CIH) approach, and it is included in the VA Directive 1137. This means that eligible veterans can have acupuncture care covered by their medical benefits package when it is clinically necessary, as determined by their care team. The VA has also established standards for the hiring of licensed acupuncturists at VA Medical Centers.

Medicare

Medicare Part B, which is the medical insurance component of Medicare, covers acupuncture for a specific condition. It provides coverage for up to 12 acupuncture visits in 90 days for chronic inferior back pain that meets certain criteria. If there is improvement in the patient’s condition, an additional eight sessions can be covered. However, if there is no improvement, Medicare won’t cover the additional treatments. In total, a maximum of 20 acupuncture treatments can be received in a 12-month period for chronic low back pain.

It’s important to note that Medicare only covers acupuncture for chronic low back pain and under specific conditions. Other conditions may not be covered. In terms of costs, under Original Medicare (Part B), beneficiaries are responsible for paying 20% of the Medicare-approved amount for covered acupuncture services after meeting the Part B deductible.

Step-by-Step Guide on How to Get Acupuncture Covered by Insurance

Acupuncture can be a significant addition to your healthcare routine, but the path to getting it covered by insurance can be a bit complex. Here’s a step-by-step guide to help you navigate this process:

Review Your Insurance Policy

Start by thoroughly examining your insurance policy. It’s a crucial first step to understand what aspects of acupuncture are covered, what’s excluded, and any specific prerequisites or constraints tied to acupuncture treatments. This knowledge is the foundation for navigating the insurance coverage process effectively.

Speak with Your Insurance Provider

Communication is key. Contact your insurance company to discuss their policy regarding acupuncture coverage. Ask for a comprehensive breakdown of the terms and conditions associated with acupuncture. Inquire about any requirements, such as pre-authorization. Being well-informed about your insurance provider’s stance on acupuncture will help you make informed decisions.

Find an In-Network Acupuncturist

Seek out acupuncturists who are part of your insurance provider’s network. Opting for an in-network practitioner increases the likelihood of your treatments being covered. This choice can lead to more favorable financial arrangements, ensuring that you get the maximum benefit from your insurance plan.

Obtain a Referral or Prescription

Depending on your policy, you may need a referral or prescription from your primary care physician to access acupuncture coverage. Make sure to follow the necessary procedures, including consulting your doctor and obtaining the required documentation for your insurance company to approve your claims.

Verification and Pre-Authorization

For policies that demand pre-authorization, be diligent in fulfilling this requirement before commencing your acupuncture sessions. Failing to do so can result in your treatments not being covered, leading to unexpected costs. Be proactive and ensure that all pre-authorization steps are completed in advance.

Keep Detailed Records

Keeping meticulous records of your acupuncture treatments is essential. Maintain records of receipts, invoices, and any relevant medical documentation. These records will be invaluable if you need to file a claim or if any disputes arise regarding the coverage of your acupuncture treatments.

Submit Claims Promptly

If your insurance covers acupuncture, it’s imperative to submit your claims promptly and accurately. Timely filing is critical in ensuring that you receive reimbursement for your treatments. Delays or inaccuracies in the claims process can hinder your ability to benefit from your insurance coverage effectively.

Appeal if Necessary

In case your initial claim for acupuncture coverage is denied, don’t lose hope. You have the right to contest the decision. When appealing, provide any additional information or documentation that supports your case. The appeal process allows you to present a stronger argument for your insurance provider to reconsider and potentially approve your claims, ensuring you receive the coverage you deserve.

Frequently Asked Questions