Acupuncturist That Takes Oscar Health Insurance
Today, more and more insurance companies are offering full or partial coverage for acupuncture treatment. However, just because your insurance company “covers acupuncture” does not necessarily mean that they will pay for your acupuncture treatment. To truly understand your insurance coverage, you need to start by asking the right questions.
Acupuncturist That Takes Health Insurance -- Silverlake Acupuncture
Does Silverlake Acupuncture accept health insurance?
The answer is YES, we do! Silverlake Acupuncture is an Acupuncturist that takes health insurance, one of very few in the Los Angeles area. In 2021, Silverlake Acupuncture is in-network with Oscar Healthcare of California and Cigna. We are also in-network with the new Cigna+Oscar plans available in wider areas of California.
Silverlake Acupuncture is also in-network with select plans of Blue Shield of California so long as they are not managed by American Specialty Health (ASH). We love our patients with insurance, and will do whatever we can to work with you and your insurance company to get you the treatment you need to improve your health.
Unfortunately, we are out-of-network with Anthem Blue Cross, American Specialty Health, Aetna, and United Healthcare. You may have out-of-network benefits available with these companies. We can submit billing for most plans with out-of-network benefits except American Specialty Health (ASH) plans.
Health care plans that pay for acupuncture often provide partial payment for acupuncture, electroacupuncture and some modalities. They do not pay for herbal formulas but you may be able to use your flexible health spending account to cover your herbs and/or your copays and coinsurance amounts.
Oscar Health Insurance Coverage
As we mentioned, we are one of the few acupuncturists in Los Angeles that take Oscar Health Insurance. But who is Oscar?
Oscar Health Insurance is the “new kid on the block” for health insurance in California. While they may be new, they bring a powerhouse full of intuitive technology tools that are designed to provide the best healthcare experience. They were founded in 2013 as Oscar Health Plan of California.
Oscar Health Insurance was one of the two new carriers that joined Covered California, the California State Exchange, in 2016. Their coverage area included the southwest region of Los Angeles County (pricing region 16) and Orange County (pricing region 18). For 2018 Oscar moved into Northeast Los Angeles which is Region 15.
A hybrid of the HMO and PPO model, Oscar effers EPOs. EPOs work similar to an HMO in that they only cover in-network services. But unlike an HMO, they do not require members to obtain a referral before visiting a specialist. We get many new patients who search for “acupuncturist that takes Oscar Insurance” or “acupuncturist that takes Cigna insurance”, and are proud to be an in-network provider for both Oscar and Cigna. Recently, Cigna teamed up with Oscar to create new products called Cigna+Oscar plans that are billed through Cigna and managed through Oscar.
That said, there is much to know about Acupuncture and Health Insurance.
Insurance For Acupuncture
Firstly, it’s important to understand that insurance companies offer many different types of policies with different benefits. Hundreds if not thousands of different health plans that might cover acupuncture, or they might not. In other words, if you have a friend with the same health insurance company as you, and that friend has acupuncture coverage, then you can logically infer absolutely nothing about whether you have acupuncture coverage in your own health insurance policy. This is because your friend’s policy most likely offers different benefits than your policy.
Similarly, if you call an acupuncture clinic inquiring about treatment and tell the acupuncturist the name of your insurance company, that acupuncturist can’t know for certain whether you have acupuncture coverage. Determining that information would require investigating your specific policy, not simply getting the name of your insurance company. Therefore, we need to start by asking the right questions about your specific health insurance policy.
Does Your Health Insurance Policy Cover Acupuncture?
Start by calling your insurance company. There is almost always a customer service phone number on the back (or sometimes front) of your insurance card. There may be a maze of telephone prompts to navigate, but eventually you should be speaking directly with a customer service representative to find out about your policy benefits.
The first question to ask is whether acupuncture treatment is covered on your policy. The answer should be either yes or no. If the answer is no, your insurance company will not pay for your acupuncture treatment … period. If the answer is yes, your insurance company may pay for your acupuncture treatment, but first we need to learn more about the details of your policy.
Coverage Limits
If you have acupuncture coverage, you should ask if there are coverage limits to the number of treatments (or dollar amount paid for treatment) and how much of these limits have already been used. If the limits have been met or exceeded, the benefit has been exhausted and you should not expect payment from your insurance company. A common limit is 20 visits per calendar year; another common limit is 12 visits per calendar year. A few plans have more complicated limits, such as 8 visits per calendar quarter, combined with physical therapy, occupational therapy, or other therapies. This combined type of limit means that you get partial coverage for 8 visits from ALL of the therapies, thus if you have visited your physical therapist 7 times in a quarter, there is only 1 visit available for acupuncture or any of the other therapies on that list.
Next, it is important to ask if there is a deductible amount which applies to acupuncture treatment. If a deductible applies, you should ask how much of that deductible has been met and what the deductible period is. You should expect to pay out of pocket until the deductible has been met for the current deductible period.
Now let's find out which providers are covered. It is most likely the case that treatment administered by one acupuncturist is covered while treatment administered by another is not. That’s because some Acupuncturists may be in-network for your policy, and others may be out-of-network.
In-Network vs Out-of-Network
Ask about the difference in coverage between an in-network provider and an out-of-network provider and how to get a list of in-network acupuncture providers. It is also wise to ask whether your policy allows acupuncture to be administered by a licensed acupuncturist or if it stipulates that treatment may only be administered by an MD. In addition, you should ask if a referral from an MD is required for your policy.
Diagnosis Requirements
Even if you have found an acupuncturist that takes health insurance, ask your insurance company if there are specific acupuncture diagnosis requirements. If you've met all of the criteria above, you still should understand that an insurance company will pay for acupuncture only when treatment is considered medically necessary and acupuncture is an appropriate treatment for the patient's condition. For example, most insurance companies will consider acupuncture appropriate for treating nausea or chronic pain such as chronic low back pain, but very few insurance companies will consider acupuncture to be medically necessary for treating Rocky Mountain Spotted Fever, as there is little evidence that acupuncture is helpful in treating this condition. Most health insurance plans do not cover acupuncture for fertility enhancement.
Although there is a lot of research indicating acupuncture is effective at treating anxiety, infertility, and skin disorders, many insurance carriers consider acupuncture to be “experimental” for treating these conditions and as such, they do not provide coverage for these diagnoses. Not all insurance companies will provide you with this type of information, but it's worth asking, as some do.
Can Your Acupuncturist Tell You If You Are Covered?
Lastly, there is a common misconception that healthcare providers have a "direct line" to the insurance company to determine benefits and eligibility, but believe it or not, providers often have to jump through the same hoops as do members, if not more. In fact, the insurance company will usually offer better customer service to its members than to the providers. After all, insurance companies know that if members are unhappy, those members can switch to (and subsequently pay their premiums to) another health insurance company. Health care providers, on the other hand don't pay premiums to health insurance companies, and as a result have less recourse.
Tips For Ensuring Health Insurance Coverage For Acupuncture
At the end of your conversation, remember to ask the customer service representative for an ID number for the phone conversation that you're having, and keep that ID number saved somewhere. In this way, if the claim is processed in a manner inconsistent with what you've been told, you can contact the insurance company and refer specifically to the conversation in which you were given different information. For the phone call ID you may be given a very long number or simply the representative's name and the current date, but either way it is worth saving until the claim has been processed in a manner consistent with your expectations.
Before finishing, I'd like to offer one final piece of advice. Don't be intimidated about calling your insurance company. You're the customer ... and you pay a lot of money for your health insurance. Get involved and become informed. You should understand your health insurance policy better than anyone else. Let your insurance company know if you're not satisfied with your service or your policy. By taking responsibility, we can help improve the system for everyone.
