Insurance Info

An increasing number of insurance companies are covering complementary and alternative medicine, fueled by consumer demand and a growing body of scientific evidence demonstrating the benefits and cost-effectiveness.

We do not bill insurance directly, however we can provide you with the proper receipts and insurance forms so you can submits claims yourself. Payment is due at the time of service.

Local HMO plans including GHC, Dean, Physicians Plus, Medicare, WPS and Unity do not cover our services. We encourage you to write to your local government representative to express a demand for acupuncture services.

Flexible Spending Accounts and Health Spending Accounts

At Isthmus Wellness most of our clients use Flexible Spending Accounts or Health Savings Accounts that use pre-tax dollars to pay for covered services including acupuncture, therapeutic massage, consultations, Chinese herbal medicine and other prescribed therapies. We are happy to provide “Super-Bill” receipts if you are submitting to a Flexible or Heath Spending Account and please let us know if you need these types of receipts.

Which Insurance Plans Cover Acupuncture?

A few national insurance providers cover acupuncture in our area and these include

  • Aetna
  • Blue Cross Blue Shield
  • United Healthcare
  • Union Insurance Plans

Please call your insurance carrier and ask these specific questions

  1. Does my plan cover acupuncture services?
  2. Does acupuncture need to be pre-authorized or pre-approved?
  3. Do I need a referral from my primary care provider?
  4. Which CPT codes for acupuncture and consultations will be covered?
  5. How many visits are covered and over what period of time (for example, 6-10 visits a year of acupuncture)?
  6. Is there a co-payment or deductible for out-of-network providers?>
  7. Will the therapy be covered for any condition or only for certain conditions? Please obtain covered ICD9 codes.
  8. Will any additional costs be covered, such as nutritional consultations and lab work?
  9. Are there any dollar or calendar limits to my coverage?
  10. If I use a practitioner who is not part of your network, do you provide any coverage? Are there any additional out-of-pocket costs?
  11. Check to see if your policy has a “clinical gap or geographic gap exception.” This is typically this done with a care coordination specialist at your insurance company. These exceptions allow coverage at in-network rates for out-of-network providers. If this is approved, you will receive a letter from your insurance carrier.

Helpful tips when dealing with insurance companies

It will help you to keep organized records about all interactions with your insurance company. Keep copies of letters, bills, and claims. Make notes about calls, including the date, time, customer service representative’s name, and what you were told. If you are not satisfied with a representative’s explanations, ask to speak to someone else.

If the insurance company requires you to have a referral, be sure to obtain it and bring it with to your first appointment at Isthmus Wellness. It’s a good idea to keep a copy for your own records.

Accident Liability and Medical Payments Insurance Coverage

If you have been involved in an accident with medical payments coverage we can provide you with the proper receipts and insurance forms so you can submits claims yourself. Payment is due at the time of service.

If you have been involved in an accident and are filing a liability claim we will provide copies of your medical records as requested for a small fee.  We can provide you with the proper receipts and insurance forms so you can submits claims yourself. Payment is due at the time of service.

 

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