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Affordable Care Act: Revisited

3/12/2014

The Affordable Care Act or ACA has been constantly in the news since October last year when the (largely faulty) exchange websites went live. Yes, the health care exchange rollout has been fraught with difficulty and enrollment has been challenging, but despite these issues, I personally feel the Affordable Care Act is an amazing success - over a million uninsured Americans have signed up for coverage already! It is truly is a landmark piece of legislation not only for America as a whole, but for Acupuncturists in particular.

Though insurance companies have been able to extend existing plans a little longer due to the 2 year grace period the feds announced last week, under the Affordable Care Act more people have access to Acupuncture and alternative medicine coverage in the United States than ever before. Under ACA, alternative medicine is poised to thrive because:

Five states (Alaska, California, Maryland, New Mexico and Washington) chose to include Acupuncture benefits as standard care in addition to the 10 Essential Benefits outlined in ACA. All insurance plans originating in these states going forward will include Acupuncture coverage!
The government’s definition for the “healthcare workforce” in America now includes Complementary and Alternative Medicine (CAM) providers, meaning a national recognition for Acupuncturists as part of the medical team.
The Affordable Care Act includes a special clause in section 2706 for “non discrimination in healthcare” which means that if insurers cover Acupuncture and Acupuncture is provided by a Licensed Acupuncturist they cannot deny coverage. In the past, some health care plans would say they covered acupuncture, but would only pay if it was provided by a Medical Doctor (with a weekend course of training or even none at all, compared to the 3-5 year Master’s Degree an LAc is required).
A new research institute was formed specifically to do outcomes based research on Complementary and Alternative Medicine treatments. In time this will GREATLY improve everyone’s understanding - CAM providers, consumers and medical doctors alike - of where CAM services provide the best benefits as compared to Western Medicine or “standard care.”

As to the last clause above, this kind of research is being done slowly but surely in Europe and has resulted in some great advances for Acupuncturists in Germany in particular. A study on back pain and knee arthritis called The German Acupuncture Trials showed that Acupuncture and standard care both resulted in approximately the same outcome. Subsequently, Acupuncture is now covered by socialized German healthcare for these conditions.

More studies like this conducted in (and therefore recognized by) the U.S. will result in everyone making better decisions about medical intervention at various stages. If you had a choice between arthroscopic knee surgery for osteoarthritis ($50,000 price tag) and acupuncture (6-12 visits at $70 each) which would you, and your insurance company, choose knowing the outcome would be approximately the same? Acupuncture is the clear winner for the average case - less expensive, less invasive, virtually risk free, natural and research-proven to be effective!

An Acupuncturists Perspective on the Affordable Care Act

From an Acupuncturists perspective, these things are a big win for our industry. The Affordable Care Act has resulted in increased access to Acupuncture by

Recognizing Acupuncturists as health care professionals on a national level
Providing for further comparative research studies that will have direct impact on how and when to use Acupuncture compared to standard care, instead of constantly researching the question “how does Acupuncture work?” which has many biomedical answers that may or may not affect utilization of services
Increasing access to healthcare overall including Acupuncture
Protecting Acupuncturists ability to provide Acupuncture as defined in scope of practice with the new “non discrimination in healthcare” law.

The Affordable Care Act is an incredible first step towards something desperately needed in our country - true health care access for all as a national right. Is it perfect? Not quite. Is it going to continue to go through changes in the coming years? Undoubtedly. But the standard has been set and (hopefully!) there’s no going back now.

Wondering if your insurance covers Acupuncture? I’m always happy to check benefits for potential patients, so if you want to check your benefits please email me your name, date of birth and health insurance information and I’ll be happy to verify your benefits before your first visit or consultation!

Until next time,

~Rebecca

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Oregon and Washington Individual & Family Health Plans Offering Acupuncture under the Affordable Care Act

10/4/2013

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Wow, what a week its been - opening of the Health Care Exchange sites, government shut down, a new hurricane?!! Eventful to say the least.

Despite the brouhaha, the Affordable Care Act is in effect NOW and new plans are ready and available for review and enrollment. It is a landmark for our nation and fundamental shift to the way we approach health care in the U.S.. Despite the glitches and kinks, I can't help but be excited about what is to come.

10 Essential Benefits

With the Affordable Health Care Act EVERYONE has access to quality insurance that covers the basics, and "the basics" refers to 10 categories must be included in every plan nationwide:

ambulatory patient services;
emergency services;
hospitalization;
maternity and newborn care;
mental health and substance use disorder services, including behavioral health treatment;
prescription drugs;
rehabilitative and habilitative services and devices;
laboratory services;
preventive and wellness services and chronic disease management;
pediatric services, including oral and vision care.

What exactly is included in these categories is slightly different state to state, however. In Washington these essential benefits include ACUPUNCTURE, 12 visits a year in fact. This means ALL PLANS be they individual or group that are purchased in Washington state will include Acupuncture benefits. How awesome is that?

In Oregon the essential benefits category inclusions do not include Acupuncture specifically, so I've done my best to review the Individual and Family plans available in Oregon to give you a quick list of which plans include Acupuncture towards helping you choose the best alternative care benefits available.

Group plans will be subject to employer review and approval so I have not combed through those here. If you are insured through your employer, however, and will be having a coverage switch in the coming year, I highly recommend you tell HR that you would like Acupuncture benefits included in your package if at all possible. Acupuncture is usually bundled with Chiropractic and Naturopathic care, as well as Massage in some cases, so advocating for alternative care coverage will help you get the best wellness maintenance and stress reduction treatment options out of your new benefits.

Oregon Individual & Family Plans Covering Acupuncture in 2014

Many of the insurance websites have been having glitches with the high volume of traffic this week, and some sites just don't list every benefit online, so my list isn't perfect but its as good as it can be in this time and place.

Here, therefore, is a list of Oregon Individual and Family Plans currently including Acupuncture coverage:

Bridge Span Health Plans - no Acupuncture coverage under any individual plans
Family Health Care - Medicare and Medicaid Oregon Health Plans only. NOTE that Medicare does not cover Acupuncture at this time. The OHP Plus plan does include Acupuncture services though the exact benefit is not listed on the OHP site.
Health Republic Insurance Company - NEW! Health Care Co-Op option. All plans cover 40 combined Acupuncture + Chiropractic Visits
Health Net - does not currently list acupuncture benefits in any of their individual & family plans but it looks like a glitch - they have traditionally covered Acupuncture and Chiropractic under all plans. I talked to Provider Relations and they indicated Health Net was not dropping Acupuncture coverage but couldn't give me specific plan details. They referred me to their Affordable Care Act information line but I have been unable to get through. Group health insurance will most likely continue to cover acupuncture. Confirm benefits with a sales person if you are considering these plans.
Kaiser Permanente - Plan details are not listed online at this time. Traditionally all Kaiser patients (aside from Medicare only coverage through Kaiser) have access to Acupuncture through referral whether they have a "self refer" benefit or not. Expect this benefit to continue, but speak to a sales representative to confirm if considering a KP plan.
Lifewise - Acupuncture included in the Gold and Broze VA plans
MODA Health - Acupuncture included in the Gold-Be Protected, Silver - Be Prepared and Silver - Be Smart plans.
Oregon's Health Co-Op - another NEW health care co-op insurance agency! Acupuncture included in SiMPLE Silver, Bronze and Gold plans as well as all Group plans
PacificSource - Acupuncture included in the Balance Bronze 6350, Silver 2500 & Silver 1500 plans
Providence - no Acupuncture coverage evident in any of the Individual & Family plans.
Regence Blue Cross Blue Shield - Acupuncture is not currently listed as a covered OR an excluded benefit in their individual plan brochure so I cannot confirm or deny coverage, but traditionally BCBS has been good at providing alternative care benefits to members.
Trilium - like Family Health Care, provides Medicare/Medicaid/OHP plans only. As with Family Health, Medicare does not cover Acupuncture but the OHP plan does though again - the exact benefit isn't listed.

If your insurer isn't listed, don't worry. Remember that this is a review of Individual and Family plans only and does not include group insurance plans many of which will have options to include Acupuncture and alternative care through your employer.

You can review plans and get quotes through the exchange websites here:

Cover Oregon

Washington

Healthcare.gov

Rebecca Accepts Insurance!

Want to make sure treatments at All Ways Well are covered? They are! I am a preferred provider with all the networks listed above except for OHP.

Stay Tuned! Until next time.

As further information about alternative care under the Affordable Care Act is available I will endeavor to keep posting updates on my blog so please stay tuned. If you have questions about your care or coverage and treatment at All Ways Well please don't hesitate to contact me via email anytime.

Have additional questions you'd like answered that I can help with or resources you need help finding? Just ask in the comments section below and I'll be happy to do my best to help you.

Yours in Health,
~Rebecca