Alaskan Acupuncture Anchorage & Homer Clinics Insurance Verification

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Insurance Information & Verification

We (or you) will need to check with your insurance provider to see if acupuncture and/or myofascial release/trigger point (manual therapy)services are covered. We will be happy to call your insurance company for you to verify insurance coverage and help you get all or part of your visit covered. Sometimes a letter of medical necessity from a physician is needed, and then your insurance will pay.

If you choose to call yourself, below you will find a form to print off and fill out as you ask your questions. Please bring the form into the office or SCAN it to info@triggerpointrelief.com, and put "ATTN: Insurance Information" in the subject line.

SINCE INSURANCE INFORMATION CHANGES CONSTANTLY, YOU NEED TO VERIFY THE INFORMATION BELOW!!

There are other companies that cover acupuncture and manual therapies (myofascial release) other than the ones listed below, and you (or we) will need to check by calling them. You are responsible for all co-payments and un-met deductibles at the time of service. Ultimately if we are billing for you and an insurance company refuses payment, you will be responsible for charges. If they refuse payment, we will work with you on a financial arrangement.

We recommend that you submit a bill anyway, even if you have been told it is not covered. Sometimes they pay anyway, so it is worth a try. Even if they deny payment at first, sometimes if you "appeal to the third level", they will pay. Sometimes they will cover services if you can prove you are saving them money, i.e. reducing medications or avoiding surgery.* We have a letter available on request that we can send to the insurance company on your behalf, encouraging them to cover acupuncture services.

*(i.e. the State of Alaska will consider acupuncture on a case-by-case basis, if you can prove you are saving the State money. This does not include GGU and other bargaining units who are now covered under plans provided by your unions/health trusts i.e. ASEA.)

Medical Necessity: This does not mean that you need a doctor’s referral or supervision. It just means you have to be treated for a legitimate medical condition, and they will not cover the excluded items listed in your booklet, such as "stress", and for cosmetic reasons. When we verify your eligibility for benefits, we have to tell them what we are treating you for, and they tell us if they will cover it.

AUTO ACCIDENTS (PERSONAL INJURY CASES)
are usually covered. You will need to check for sure, and see if you need a written referral from a doctor. We will bill the insurance company for you.

ALASKA ELECTRICAL HEALTH AND WELFARE FUND
covers acupuncture for pain only. (Covered at 80% until the out-of-pocket amount is reached, then at 90%. No limit on the number of visits.) No medical massage/manual therapy benefits.

Alaska Laborers Construction Industry Health & Security Fund covers acupuncture.

Alaska Native Tribal Health Consortium covers acupuncture at 80% with 12 visits per year, and massage with no limit to the number of visits, both at 80%. $200 deductible, until $1200 is paid out-of-pocket, then at 100%.

ASEA HEALTH TRUST (State of Alaska GGU bargaining unit) covers Manual Therapy (myofascial release) with a referral from a Physician, Chiropractor, or a Nurse Practitioner.

BLUE CROSS (Alaskan Acupuncture is a Blue Cross of Washington and Alaska Preferred Provider)
Some Blue Cross plans are now covering acupuncture, if it is a group plan where the employer purchased a plan that includes acupuncture. If acupuncture is covered, medical massage is covered through this office. Some Blue Cross plans cover medical massage/manual therapy through an acupuncturist, even if acupuncture itself is not covered. Employers who have selected acupuncture include:

        Alaska Bar Association (12 visits/year, $20 co-pay and then 100% of the maximum allowed)
      Alaska Public Employees Association (Details unknown)
       Catholic Community Services has Blue Cross of California. They cover acupuncture for pain management only. (12 visits/year, maximum $25/visit, with a $15 co-pay, so they only cover $10/visit)
      Crowley Marine Services - covers acupuncture at 80%, 12 visits/year, with the deductible specially waived for this service.
      Holland America - has Blue Cross of Washington. (12 visits/year, covered at 80%, $300 individual deductible)
      Inland Boatman's Union - covers acupuncture at 80%, 12 visits/year, with the deductible specially waived for this service.
      South Central Peninsula Behavioral Health allows 12 acupuncture visits and 45 Massage/Manual Therapy appointments. Because we are in-network, your co-pay is 20%.
      University of Alaska - allows unlimited number of visits for acupuncture, covered at 80% until you have met your out-of-pocket maximum, then at 100%.

There are many others, as this plan is gaining popularity quickly. (Check with Blue Cross for your particular plan – it can be different, even with the same employer.) Encourage your employer to select this plan/option in the future.

Check with Blue Cross for verification.

The Federal Blue Cross plan allows the employee to purchase additional coverage that covers acupuncture, for visits to acupuncturists who are preferred providers (Alaskan Natural Care Clinic is a preferred provider).

FEDERAL EXPRESS (Fed Ex)
insurance covers acupuncture. (20% co-pay, $150 deductible, no restrictions other than conditions not allowed by your plan.)

FEDERAL PLANS
The Federal Plans that we are aware of at this time that cover acupuncture are Mail Handlers (see http://www.mhbp.com), Letter Carriers, and some Blue Cross Plans. All Federal employees have the option to elect these plans. But check to make sure, since coverage changes all the time.

GOLDEN RULE
Golden Rule covers acupuncture.

HEALTHCOMP
HealthComp covers a maximum of $500 for acupuncture, chiropractic, naturopathy, and manual therapy combined, at 80%. $400 deductible until an out-of-pocket of $3500 is reached, then at 100%.

MEDICARE, Medicaid, and Denali Kid Care do not cover acupuncture or medical massage.

NEA ALASKA (Teachers, except for Kenai Borough teachers)
are covered at 85%, with a $100 deductible. You do not need a referral from a doctor. Unlimited number of visits per year.

MERITAIN (previously RBMS) has 50 different plans, so coverage varies by plan. Our office will need to call the insurance company for specifics.
   Known Covered Plans:
   Alaska USA Credit Union has a $100 deductible, pays 80% of charges, has no maximum number of visits per year, and requires medical necessity & verification of claim.
   Kenai School District covers acupuncture and manual therapy (performed by an acupuncturist) at 80%. Unlimited number of visits, as long as medically necessary.
   SouthCentral Foundation covers unlimited acupuncture visits, and 30 massage visits with no referrals. Manual therapy requires pre-authorization since the plan is "silent" on that benefit.

UNITED HEALTHCARE has several plans, so coverage varies by plan.

Wells Fargo Bank employees get 26 acupuncture visits/year, and 20 manual therapy visits, covered at 80% once your deductible is met.

WORKER'S COMPENSATION
covers acupuncture and manual therapy/myofascial release, and you will need to bring a doctor's written referral to the office on the first visit. We will need to confirm coverage with the company prior to your appointment, so be sure to tell us this is a Worker's Comp case. You will want to check to make sure your case was opened. We are required to bill Worker's Compensation for you.

HEALTH CARE REIMBURSEMENT ACCOUNTS and MSA's:
These accounts allow you to set aside pre-tax dollars and use it to pay for expenses your regular plan does not cover, such as deductibles, your co-pay amount, and non-covered expenses such as acupuncture (allowed items are listed in IRS publication 502, "Medical and Dental Expenses"). Medical massage is not covered. The advantage is that you do not pay taxes on this money (FICA, Medicare, and Federal Withholding). There is a maximum you can contribute per year. The State provides their employees with this option, and if you are self-employed you can set up an MSA through some insurance companies. For the State of Alaska employees, you need to elect this option and state the amount you will contribute during your open enrollment period (in May), then that amount is deducted from your paychecks. (You have to elect a HCRA annually if you want to be covered for the subsequent benefit year!) You need to use-it-or-lose-it during the benefit year, but you can spend it before you have contributed all of it (i.e., you can spend $500 in the first month, even if you have only contributed $50 at that point). The State does not charge an administrative fee to administer your HCRA account. For more information, contact your Retirement and Benefits section.

For self-employed MSA's, the rules are different, in that you can accumulate the unspent money and take it out after age 65 (like an annuity). You contribute monthly amounts, but you may contribute additional amounts during the year up to a maximum amount in lump sum contributions.

PHONE VERIFICATION OF INSURANCE COVERAGE FOR ACUPUNCTURE

Date of Call ____________    Time of Call ____________ Person Making Call ____________________

Patient's Name __________________________________ Insured's Name _______________________

Date of Birth _____________________
Social Security # ________________________________   ID # ________________________________

Name of Insurance Co. ___________________________   Claim No. __________ Group No. ________

Insurance Co. Address ____________________________ Phone No. (800)_____ - ________________

Phone Hours ____________________________________

Call your Insurance Company and say you want to verify coverage for in-patient/out-patient benefits for a provider.

QUESTIONS:

1. Does my policy cover acupuncture performed by a Licensed Acupuncturist?    [ ] Yes    [ ] No
    (Procedure Codes 97810 & 97811. Request that you be directed to where you can find a copy of the
     provisions regarding Acupuncture)

2. Does my policy cover acupuncture performed by a physician or PT, except in "Underserved Areas?"
[ ] Yes [ ] No If so, is [place], Alaska considered an "Underserved Area"? [ ] Yes [ ] No

3. Does it make a difference if a medical physician writes a prescription? [ ] Yes [ ] No
Does it make a difference if a medical physician determines it is medically necessary? [ ] Yes [ ] No

4. Will it be covered for certain conditions only? (i.e., some companies pay for pain only)
[ ] Yes [ ] No

5. Will you consider paying for acupuncture treatments on a case-by-case basis, if it will save your company money? [ ] Yes [ ] No

6. Will you pay for the office visit portion of the appointment, even if you will no cover the acupuncture portion?

IF YES, then:

6. Is a portion covered under Major Medical Benefits? [ ] Yes [ ] No What percentage? ______

7. Is a portion covered under Basic Benefits? [ ] Yes [ ] No What Percentage? _______

8. Is it covered under a Health Care Reimbursement Account/Medical Savings Account? [ ] Yes [ ] No

9. What are the benefits for out-patient/office clinic? ______________________________

10. Is there a yearly maximum on Acupuncture? [ ] Yes [ ] No

11. If so, has any been used? [ ] Yes [ ] No How much? _________________

12. Is there a lifetime maximum on Acupuncture? [ ] Yes [ ] No

13. If so, has any been used? [ ] Yes [ ] No How much? _________________

14. Do you pay for Heat Therapy under an acupuncture license (97010)? [ ] Yes [ ] No

15. Do you pay for Manual Therapy Techniques under an acupuncture license (97140)?   [ ] Yes   [ ] No
       Do you pay for Massage Therapy under an acupuncture license (97124)?                   [ ] Yes   [ ] No
       Do you pay for Therapeutic Exercises under an acupuncture license (97110)?             [ ] Yes   [ ] No

16. Do you pay for Nutrition Therapy Assessments under an acup. license (97802 & 97803)? [ ] Yes [ ] No

17. Is there a deductible? [ ] Yes [ ] No How much is it? _________________

18. How much has been met? _________ When is another deductible due? ________________

19. Until what age is the patient eligible? (If under 20) _____________

Do they need to be a full time student? [ ] Yes [ ] No

Do you need verification of student status? [ ] Yes [ ] No

20. Do you honor assignment of payments? [ ] Yes [ ] No

21. Which codes do you base your fees on? [ ] CPT [ ] RVS

22. Do you require reports? [ ] Yes [ ] No

23. How often do you require re-exams? ____________________

Address of claim office for Acupuncture ___________________________________________

____________________________________________________________________________

To attention of: (Name of person) __________________________________ Dept. ______________

Name of person you spoke with: ____________________________________ Title _______________

Alaskan Natural Care, Inc. info@triggerpointrelief.com (907) 435-7060

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