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Anchorage Acupuncture
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Insurance Information &
Verification
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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.
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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%. |
| Anchorage Municipality
covers acupuncture at 80%, with a $250 deductible until $2000 is
paid out-of-pocket, then at 100%. No limit on number of
visits or other restrictions, but a Letter of Medical Necessity
is required after 20 visits. |
| ASEA Health Trust (State of Alaska
GGU bargaining unit) starting July 1, 2011, covers
20 visits per fiscal year (July 1) total for acupuncture, massage therapy,
and/or chiropractic appointments. |
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BLUE CROSS
(Alaskan Natural Care
is a Blue Cross of Washington and Alaska Preferred Provider)
Blue Cross plans are now covering 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.
Some employers/groups
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.
Federal Blue Cross plan
- check plan for details.
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%.
Check with Blue Cross for verification.
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FEDERAL EXPRESS (Fed Ex)
insurance has covered acupuncture in the past. (20% co-pay, $150 deductible, no restrictions
other than conditions not allowed by your plan.) Current coverage
unknown. |
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.
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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% for both acupuncture and myofascial release, with a $50 deductible. You do not
need a referral from a doctor. Unlimited number of visits
per year. Starting 7/1/11, for
acupuncture visits, a letter of medical necessity will likely
need to be submitted with the initial claim for most
conditions. Acupuncturists are under the EBMS definition of
"physician." |
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. |
| State of Alaska Retired
(Wells Fargo) does not cover acupuncture. |
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. |
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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.
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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 _______________
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