Insurance Information

Medicare and Medicaid do not cover acupuncture treatments. If you have a 2^nd insurance carrier that supplements your Medicare plan, that 2^nd carrier may cover acupuncture. However, our office is not able to submit bills to Medicare to get the denial required to access this supplemental coverage. You will need to pay for the visit out of pocket at the time of the treatment and ask for a receipt. You can then submit this receipt to Medicare to get a denial and then you can submit the receipt with the denial to your supplemental plan.

In the case of Auto Accident Claims, there is a lump sum of funds available for any medical expenses as a result of the auto accident. Acupuncture treatments can be submitted against the auto accident claim but will often need to first be submitted to your primary health insurance carrier for a denial before being submitted to the Auto insurance claim. This results in a delay of several months between when a treatment is performed and when the payment comes into our office.

NOTE: This means that we may not know that the funds are exhausted until after you have had several treatments beyond the last covered treatment. Once the lump sum available for medical expenses is exhausted, the patient must pay out of pocket for any further treatments and pursue repayment thru legal channels. You will receive paperwork from our office explaining this process in more detail if you are here under an Auto Accident Claim.

In the case of Workers Compensation (WC) Claims, all treatments must be approved by the WC carrier prior to treatment. You must first request and receive approval for an initial evaluation before being seen for your first appointment. Please bring paperwork confirming approval for the initial evaluation and all billing information needed including claim number, Insurance company name, address, phone number, name of the adjustor handling the claim, and the date of injury to your first appointment. Our office will then submit a treatment plan and request a certain number of treatments.

Typically, WC will only approve up to 16 treatments. Once further treatments are denied, the patient must pay out of pocket for any further treatments and pursue repayment through legal channels.

These accounts usually reimburse for Acupuncture. Be sure to ask the receptionist for a computer generated receipt at each appointment in case you are required to submit documentation for reimbursement.

Most Massachusetts BCBS plans do not cover acupuncture. They do, however, give you a discounted rate. It is your responsibility to call your BCBS plan and ask about coverage/discount benefits. (See section below regarding what questions to ask).

Please bring your card to your first visit so that we can make a copy of it for our records. Many BCBS plans from other states do offer coverage for Acupuncture. However, since we are considered an “out of network” provider, they will not send payment to our office. Instead they will send payment to you. For this reason we require that patients in this category pay the full charge for the treatment at the time of the visit. We will provide you with a computer generated receipt which you can submit for reimbursement.

There are a few local employers who do offer some Acupuncture benefit through their HNE benefit plans. Please call the HNE phone number on your card to find out if you may have coverage. We do not participate with the discount plan offered thru HNE plans.

There are a variety of Cigna benefit plans that offer coverage for Acupuncture. Copays and number of allowed treatments vary from plan to plan. There is a limited list of diagnoses covered for all Cigna plans. Please call Cigna to check on the specifics for your plan.

There are hundreds of Insurance plans available and the individual benefit plans for each are too numerous for our office to keep track of. If you have a plan other than the ones listed above, please call your Member Services phone number listed on your card (be sure to get the name of the person you speak to) and ask the following:

1. Is there coverage for acupuncture?
2. If yes, are there any restrictions in terms of diagnosis, provider, or place of service?
3. Is there any precertification or referral required?
4. Is there a limit to the number of treatments per diagnosis or per calendar year?
5. Is there a co-pay and/or coinsurance amount I am required to pay?
6. Do I have to meet my deductible first before coverage begins?
7. If there is no coverage, are there any discounts* that you are eligible for through your plan?

*Many Insurance plans offer discounts thru some sort of affinity program. This is an arrangement that the insurance company has with certain providers to offer their members treatments at a discounted price. This is not the same as coverage. You will be required to pay the discounted rate at the time of the visit. Please note that we do not participate with all the discount plans offered by insurance companies.

Be sure to bring your insurance card with you to your first visit if you think you might have coverage or a discount thru your plan.

If you have any questions regarding any insurance related issues, please call the practice manager Barb April: (413) 366-5601.