One of the most common conversations I have with new patients over the phone goes something like this:
Inquiring mind over the phone, “Does insurance cover Acupuncture?”
Rebecca, “Yes! In fact over 60% of my patients have insurance that covers treatment.”
Inquiring Mind, “REALLY??!! Does MY insurance cover Acupuncture?”
Rebecca, “I don’t know, but let’s find out!”
And quite commonly, patients DO have coverage! Here in Portland we are extremely lucky. Indeed, as the conversation above illuminates, over 60% of my patients actually have insurance that covers Acupuncture. These patients are typically responsible for a $10-$20 copayment at time of service and nothing else, the rest of their treatment is covered 100%.
With the advent of the Affordable Care Act, more people have Acupuncture coverage than EVER before but many people don’t realize it or don’t know how to utilize their benefits. In Washington in particular, 12 Acupuncture visits per year are included in the state essential benefits plan, meaning that all insurance plans originating in Washington State include Acupuncture benefits.
Understanding insurance benefits can be very confusing, however, so today, in an effort to help you understand your insurance, I’m going to walk you through how to determine if you have Acupuncture coverage, how to get Acupuncture coverage, and some insurance terminology basics to help you navigate the tangled web of coverage insurance companies weave.
How to Determine if You Have Acupuncture Coverage
Finding out if you have Acupuncture coverage is quite simple, but finding out what is covered can be hard if you don’t know the right questions to ask. Acupuncture isn’t always covered for everything - despite the 3,000 years of history behind it.
Here is a simple step by step guide to finding out all the pertinent information about Acupuncture benefits under your insurance plan. Have a piece of paper and a pen ready to record your answers:
Acupuncture is NOT Covered Under My Plan! How Do I Get Benefits?
Not every insurance plan will cover Acupuncture, but if yours doesn’t and you want to get Acupuncture treatment don’t fret - there are options. First, of course, you need to determine if Acupuncture coverage would be more cost effective than paying out of pocket.
The average 60 minute Acupuncture treatment costs somewhere between $65-$90 in the Portland area (might be different in your town, a quick web search will yield results). An average course of treatment is probably 6 treatments for any individual illness, 12 on the high end. 12 treatments at a $75 average = $900 per illness or injury, so if you’re paying more than that per year for extra insurance coverage you’re probably wasting your money and would be better served by paying out of pocket.
If you utilize other services, like Chiropractic and Naturopathic treatment as well, or if you intend for Acupuncture to be part of your regular wellness and stress management care (it should be!), then paying more in premiums would be worth it since CAM services are often combined.
If you want coverage and you don’t have it, therefore, you have two basic options:
1. Purchase additional or secondary insurance coverage
2. Lobby your HR department to add Acupuncture as a covered benefit for an employer-provided health insurance plan.
If you want to purchase additional or secondary coverage, the first thing to do is to call Member Services for your current insurer and ask about options. They may have an additional rider you can purchase which will add more benefits to your current plan for a monthly premium. If they don’t, you can go to the Healthcare Exchange and purchase a secondary plan. I compiled a list of plans from the Cover Oregon site which cover Acupuncture back in October which you can review on my blog HERE.
Purchasing a secondary insurance plan can be costly, however, so you have to think about your healthcare needs and choose wisely. Secondary coverage that compliments your current plan benefits can often result in almost never paying for any treatment for anything - whatever isn’t covered by your primary insurance can be billed through to your secondary insurance plan and will likely be covered - but premiums can be high on individual plans, so do your math carefully.
If you are insured through your employer, lobbying for Acupuncture benefits to be added to the company plan is your best option to get care. If you can get other people in your office to toot the Alternative Medicine Coverage horn, all the better. Your employer wants to keep you happy (or they should anyway!) and Acupuncture is great way to do so! People that utilize CAM services such as Acupuncture, Massage, Chiropractic and Naturopathic care are generally more aware of and engaged in their health, and healthier people have lower premiums for group health insurance. This is a big benefit to your employer because it means they are going to pay less to insure you over time because you will be healthier (are you taking notes to bring to HR yet?…)
Acupuncture in particular has been proven to reduce blood pressure, assist in weight loss and reduce stress hormones in the blood stream - all common concerns in an office environment. Acupuncture coverage, if utilized therefore, is a big benefit for employees and employers alike.
If you need help making the case for Acupuncture coverage in your office, contact me! Or your local Acupuncturist for some specific key words and phrases to bring to your HR department.
Understanding the Basics of Insurance Terminology
Insurance is about the using the money of the many to cover the needs of the few. Everyone pays premiums, but only those in need seek care requiring the insurance companies to pay up, and in this way the insurance company can make sure there are funds available as needed for everyone. Or at least that is the theory. Its a balancing system, a balancing act, and a darn confusing bunch of jargon and terminology.
The most confusing part of accessing benefits for most people is understanding their deductible. Some benefits are subject to deductible, meaning the deducible must be met before the benefit will kick in, while other benefits are not subject to deductible, which means you can access the benefits immediately and are only responsible for a copay or coinsurance amount whether you have met your deductible or not. This is where most people get confused about Acupuncture and alternative care benefits in particular, because this is very individual plan by plan.
For example: if Acupuncture is a covered benefit but is subject to deductible, you must meet your deductible - meaning you must pay for that dollar value worth of medical services (any covered medical services) before your benefits will kick in. If Acupuncture is not subject to deductible, it doesn’t matter what your deductible is or whether you have one or not, Acupuncture treatment will be covered immediately at your copayment or coinsurance rate.
Here is a list of the insurance terminology that people find most confusing and what it means for your benefits:
Deductible - this is a dollar amount you must meet out of pocket before certain benefits “kick in.” There is typically a separate deductible for “in network” and for “out of network” providers. For example, if you have a $500 in network deductible and then a coinsurance of 20%, you would be required to pay $500 worth of medical expenses (doctor visit fees, lab fees, etc) for in network services out of pocket at the start of the plan year. Once that value had been met, you would only be responsible for 20% of the fee charged for any visit or service.
In Network vs. Out Of Network - In Network providers (doctors, hospitals, medical professionals) have contracted with the insurance company and provide reduced rates to plan members. Out of Network providers have not contracted with the insurance company and can charge whatever they want.
Coinsurance - Coinsurance is the percentage of total (contract rate for in network) fees you, as the patient, are responsible for paying. It is often different in network vs. out of network. Benefits which have a coinsurance amount due are usually subject to deductible, meaning you must meet the deductible first before you can pay only the coinsurance amount.
Copayment - this is a flat dollar value that you are responsible for paying for treatment. It is often different in network vs. out of network, or you will have a copayment in network and a coinsurance out of network. Benefits which have a copayment are usually not subject to deductible, meaning you can access that benefit immediately without meeting any deductible amount for the plan year.
Plan Year - the date on which your insurance benefits reset, meaning the date you are responsible for meeting your deductible again. Insurance plans run on 12 month cycles and the plan year is usually the same as the calendar year, but can vary with some insurers.
Complementary and Alternative Medicine or “CAM” Services - This generally refers to Acupuncture, Chiropractic, Massage and Naturopathic care. Sometimes these services are bundled into a single category meaning you have one benefit pool to share among them. Physical Therapy is always separate from CAM services, and Chiropractic is often singled out as a separate benefit as well.
Authorization - Some benefits require authorization before they can be utilized. Services that require authorization typically require the provider him or herself to seek authorization on or before your first visit for treatment. If not authorized, the insurance company will not pay for treatment.
Referral - Some benefits require a referral, typically from your PCP or Primary Care Provider, before the insurance company will pay for them. In Oregon an MD, DO (Doctor of Osteopathy), ND (Naturopathic Doctor) or DC (Doctor of Chiropractic) can be a Primary Care Physician, but an ND or DC must be covered under your specific insurance plan despite state law to be recognized as a referral party.
Contact Rebecca with Questions
Insurance can be confusing, but with a little know how and a provider who knows the ropes on your side, everything can be understood and clarified with ease. If you have questions about your insurance plan, contact me via email anytime or book a free consultation online. I am happy to help navigate your benefits!
Until next time,
Do you experience any of the following symptoms:
The reality of food today is that food isn’t what it used to be. If you aren’t able to eat organic, meats can be full of harmful hormones, and non-organic genetically modified fruits and vegetables can hold less than 10% of the nutrients found in their organic counterparts. Vitamin deficiencies, therefore, are more common in the United States than many people realize. Furthermore, almost all the symptoms listed above, can be taken care of by a simple daily multiple vitamin!
Getting the Most out of Vitamin Supplements
Before you run out to the grocery or health food store and grab a multi, however, be warned - recent research has shown that many vitamin supplements over the counter falsely advertise their contents. Probiotics have been found to contain E.Coli, and herbal remedies sometimes have completely different herbs in them than what the bottle says! Are there over the counter brands you can trust? Yes, especially for basic single nutrients like Vitamin C or Magnesium, but for multi vitamins and herbs, it is always recommended to get them from a trusted provider.
Acupuncturists, Naturopaths and Nutritionalists have access to provider only brands that undergo much more rigorous testing than what you find over the counter, and who guarantee the contents of their products. This is in part marketing driven - more expensive brands want to be trusted and want to engender brand loyalty. To be trusted, they spend time and money on making sure their products test true and make a measurable difference in treatment outcomes. They spend more money on their products and guarantee purity, and the investment pays off - these brands are more expensive, but they are trusted and the do make a difference so they are worth the money.
The other important distinction of provider-only brands compared to over the counter vitamins, is that they are guaranteed to be bioavailable. Many over the counter supplements contain tablet binders that your digestion can’t get through to actually make use of the vitamins inside. Provider only brands, such as Standard Process, Seroyal and Biotics NW to name a few, use binders that are antioxidant rich and tested to ensure that they break down easily in your digestion so you can feel confident that your body can actually get to the nutrients inside. These brands are arguably the best vitamin supplements available.
How Do I Get the Best Vitamin Supplements Available?
To get the best supplements available, and the right selection for your needs, its ideal to see a provider. I always encourage all of my patients to take a basic multi vitamin, an Omega Fatty Acid supplement, vitamin D and probiotic for optimal health and I actually created my All Ways Wellness program around this concept.
You can also order and refill prescriptions for provider only brands through my Emerson Ecologics Virtual Dispensary HERE.
If you’re interested in learning or more, contact me via email anytime or book a free consultation online. I always include nutritional and herbal counseling in all my acupuncture sessions as indicated for your unique case!
Until next time,
When the Olympics were in Beijing in 2008 Cupping therapy made a big splash (pun intended…) as many Chinese athletes were seen mounting the blocks with cupping marks on their backs. You know, the ones that look like a giant squid or octopus attacked them?
Even though these prominent athletes were spending lots of time in the water, there was no creature from the deep motivating their training efforts - they were merely partaking in the benefits of Traditional Chinese Medicine for sport enhancement. I have to admit that Cupping is by far one of my favorite accessory therapies in Acupuncture and Chinese Medicine. Yeah, cupping…. so cool…
What Is Cupping?
What is cupping you ask? Cupping involves using glass, silicone, plastic or bamboo cups to create suction which relieves pain by increasing Qi and Blood flow to the local area. It also removes sha (stagnation) from the body by bringing it to the surface where your body can flush it out more easily. This makes it an excellent addition to any type of detox treatment. It can be done anywhere on the body, but the back is the largest body surface available so that is where cupping is most commonly used.
In Chinese Medicine the back is also dominated by the Bladder Channel which is dotted with access points called “Back Shu” points for all of your internal organs. These organs correspond to the 12 main meridians in the body - Bladder, Kidney, Liver, Gallbladder, Spleen, Stomach etc. - and cupping over Back Shu points specifically can activate the channels and effect change along the entire channel pathway.
Furthermore, cupping is often used to open a specific area of the upper back called the “wind gate” where colds and flu’s are believed energetically to enter the body and make you ill. These “evil pathogenic invaders” which make us sick can be carefully vented out of the body via the wind gate to alleviate the symptoms of colds and flu’s thereby shortening the duration of illness.
This makes cupping a powerful needle free therapy that can be used alone or, most commonly, in conjunction with Acupuncture to increase the effectiveness of treatment.
In Western Medicine terms, it is considered a myofascial release technique like deep tissue massage, and the experience for most people is much the same. Most people find it quite relaxing and feel like their muscles have been released and that knots have been worked out by this treatment.
What Are the Benefits of Cupping?
The primary benefits of cupping are Pain Relief, Relaxation and Detoxification. Cupping has many benefits and far reaching application, however, and can be used for:
Another benefit of Cupping therapy is that it can be done without Acupuncture if desired, and is therefore a highly effective needle-free Chinese Medicine treatment. It is also safe for children of any age, and in China it is a common home therapy for young children who are ill.
In conclusion, Cupping therapy is a simple yet profound and ancient technique for healing the body on multiple levels. It is safe, effective, needle free and can be done as part of Acupuncture treatment or as a stand alone intervention. At All Ways Well, I often integrates cupping into treatment to enhance and prolong the effects of Acupuncture and help patients reach their goals faster.
Questions? Contact Rebecca!
A coach once gave me an analogy I never forgot - that life is a juggling act and while most of the balls will bounce, health can be made of glass; if that ball breaks, it might never go back together quite the same.
The key message? Health MUST be a priority in the juggling act we call life because of all the things we can recover from, a true health crisis can change our lives irrevocably and irreparably.
Take a Lesson from the Heart - Put Your Health First
Another good way to bring this message home, is to take a lesson from our own body processes - from the heart specifically. In our own bodies, the Heart actually pumps blood to itself first before it pumps blood anywhere else in the body. This is because the body knows that without proper nourishment of the Heart, everything else in the body will fail.
Our lives are the same - if we don’t take care of ourselves, we cannot take care of anything or anyone else in our lives. Its imperative to put your health first, to have an eye on preventative care and stress management in particular, so that you know you are doing everything within reason in this moment in time to take care of yourself. If you can do that, you are much more likely to continue leading the long and healthy life you want to live.
A Plan for Self Care that Works For YOU
If you don’t want to drop that glass ball, you’ve got to keep your eye on it, and the best way to do that is to have a plan for self care. I believe a successful self care plan needs to be simple and flexible because at different times in our lives (or even day by day) sticking to our plan can be more or less difficult. Your self care plan needs to assist and support your health, not stress you out, but you also have to be accountable to your goals to succeed in them. Having a plan can help you in all these areas.
Devising your plan can be a simple exercise in assess, plan, execute. Then revise and repeat whenever necessary.
STEP ONE - ASSESS
You might know this right off the top of your head, but if you don’t take 5-10 minutes to make a mental tally (or physical list, your choice) of the areas you feel you are successful with your self care and the areas you feel you could improve. It should be something simple like this:
It doesn’t need to be exhaustive, but I do recommend including these categories - diet, exercise, sleep and stress. You can include as much or as little detail in these areas as you want, and you can also include any other areas you like that directly affect your health, such as self care, family time, sport, etc.
If STRESS is in the “weak” list, meaning it is too high or uncontrolled, make another list like this:
Now you have a clear picture of your strongest and weakest areas. Your goal? Create a plan that will shift more into the “strong” column and the “stress reducing” columns of your lists.
STEP 2 - PLAN
You can be as simple or as complex as you want with your plan. The most important part is that you are devising a plan you can achieve. You can revise your plan as often as you want, so set goals you can reach in a reasonable period of time to ensure success and motivate you to keep making positive changes.
For example, if Sleep and Stress are the biggest items in the “weak” column, choose these two areas to focus on and pick one or two activities that will help you improve them. Better yet, choose one activity that can help with BOTH. For Sleep + Stress there are two primary activities that come to my mind - Exercise and Acupuncture. Exercise and Acupuncture can both drastically improve sleep and stress, and if you combine the two its a magic double whammy!
Schedule time for these activities as part of your plan - for example, decide that you are going to exercise 2x/week on specific regular days/times or book an acupuncture appointment once a week.
To complete your plan, choose a timeline for these activities during which you are going to focus on doing them and not worry about assessment or about what comes next. For this length of time, you are just going to walk the walk. You’ll look back and see what happened later. It could be 3 weeks or 3 months, but whatever it is set it, schedule a reminder when the time is up, and forget it.
Now its time to EXECUTE.
STEP 3 - EXECUTE
Okay, execute the plan! Some days or weeks it is going to work great, other days and weeks its going to be hard. That’s okay. Right now all you have to do is do the doing and accept that all you can do is all you can do and that’s just how it should be.
REVISE AND REPEAT
Once you reach the date you set to look back, take a moment to go back to step 1. Run your list again and see how you did. Did anything shift out of “weak” into “strong?” Are your plans working for you in your life or do they need to be revised? Do you just need to walk the walk a little longer on these goals or is it time to choose a new focus to get in line?
I know these are a lot of questions, but they will be intuitive as you look at your list and seek to shift more items into the strong column. It will only take you a few minutes, and it will help you keep that glass ball in play as long as you can bring yourself to focus on it.
You Don't Have to Go It Alone
At a minimum, I recommend doing this exercise quarterly with the change in seasons - it is a natural time to assess your health and your goals. If you reach your goals quickly or want faster change you could repeat it weekly or monthly even - its totally up to you.
If you look at this exercise and feel too daunted, then don’t do it alone - your friendly neighborhood Acupuncturist is an expert in preventative medicine (we have 3,000 years of clinical data behind us which supports living a healthy balanced life!)
In my practice, in addition to helping my patients reach their immediate health care and pain relief goals, I always have an eye on improving my patient’s health long term. As a holistic medicine tied to the seasons and body rhythms, in my mind there’s just no other way - Acupuncture can’t treat anything without treating a little bit of everything. If you’re looking to keep your eye on the ball, Chinese Medicine has a plan to help you.
If you have questions or want help devising your own plan, contact Rebecca via email anytime, or book online anytime! You can also post in the comments section and I’ll do my best to address your concerns.
Until next time,
Rebecca M H Kitzerow is a Licensed Acupuncturist practicing in La Center, Washington. With over a decade of experience she has won 10 Nattie consumer choice awards from Natural Awakenings Magazine since 2014.