Acupuncturist That Takes Oscar Health Insurance
Today, some insurance companies like Oscar offer full or partial coverage for acupuncture treatments. 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 must ask the right questions. Then, you have to find an acupuncturist that takes your insurance. And, if you use Oscar, you’ve just found an acupuncturist that takes Oscar.
Acupuncturist That Takes Oscar Health Insurance -- Silverlake Acupuncture
Silverlake Acupuncture is an acupuncturist that takes Oscar health insurance, a bit of a rarity in the Los Angeles area. Because we take insurance, we will work with you and your insurance company to get you the treatment you need to improve your health.
We are in-network with Oscar Healthcare of California and Cigna+Oscar plans (available in wider areas of California). We are also in-network with select Blue Shield of California PPO plans so long as they are not managed by American Specialty Health (ASH).
Which Insurance Do We Not Accept?
We are out-of-network with Anthem Blue Cross, Aetna, and United Healthcare. However, if you have out-of-network benefits with one of these providers, we can submit billing for out-of-network benefits except for ASH-managed plans.
Independent Physicians Associations (IPAs) are another type of health insurance organization we do not typically accept. Even if Oscar, Cigna, or Cigna+Oscar provides your health insurance, if your particular plan belongs to an IPA, we do not accept it.
How Can You Tell if Your Plan is Part of an ASH or IPA Group?
The best way to tell if your health insurance is part of an ASH or IPA group is by checking your insurance card. Look for the ASH or IPA designation somewhere on your card, typically on the back.
Oscar Health Insurance Leaving Covered California
An important note to people who get their Oscar Healthcare Insurance through Covered California. Effective January 1, 2024, Oscar Healthcare will no longer participate in Covered California. Oscar will continue to offer PPO plans in California but not through the state’s insurance marketplace. We encourage you to talk with your insurance provider or agent for more information.
Learn About Health Insurance for Acupuncture
Firstly, it’s important to understand that insurance companies offer many policies with different benefits. Hundreds if not thousands of health plans might cover acupuncture, or they might not. Suppose you and a friend have health insurance with the same company, and that friend has acupuncture coverage. Then, you can logically infer absolutely nothing about whether you have acupuncture coverage in your health insurance policy. This is because your friend’s policy most likely offers different benefits than your policy.
Similarly, calling an acupuncture clinic inquiring about treatment and telling the acupuncturist the name of your insurance company, that acupuncturist can’t know with certainty 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 must ask the right questions about your health insurance policy.
Finally, some healthcare plans that say they cover acupuncture usually only partially pay for acupuncture, electroacupuncture, and some modalities. They do not pay at all for herbal formulas, but you can use your flexible health spending account to cover your herbs and/or your copays and coinsurance amounts.
Does Your Health Insurance Policy Cover Acupuncture?
Start by calling your insurance company. There is almost always a customer service phone number on your insurance card’s back (or sometimes front). There may be a maze of telephone prompts to navigate, but eventually, you should speak directly with a customer service representative to learn about your policy benefits.
The first question to ask is whether your policy covers acupuncture treatment. The answer should be either yes or no. If the answer is no, your insurance company will not pay for your acupuncture treatment. 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.
If you have acupuncture coverage, you should ask if there are coverage limits to the number of treatments (or dollar amount paid for each 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 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 other therapies on that list. This combined limit is common with most Screen Actor Guild (SAG) plans offered through Anthem.
Next, it is essential to ask if there is a deductible amount that applies to acupuncture treatment. The deductible may be different for in-network providers than it is for out-of-network providers. If a deductible applies, you should ask how much 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.
In-Network vs Out-of-Network
Now, let's find out which providers are covered. Treatment administered by one acupuncturist may be covered, while treatment administered by another may not be covered. That’s because some acupuncturists may be in-network for your policy, and others may be 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. Additionally, ask if your policy requires a referral from an MD. Written referrals are almost always required when the plan is an IPA or HMO, and those referrals are usually specific to the acupuncturist, rather than to any acupuncturist you find yourself. These referrals usually also require a written authorization from the insurance carrier or IPA, or both. Authorization needs to be obtained by the patient and/or referring doctor before your acupuncture visit.
Even if you have found an acupuncturist who takes health insurance, ask your insurance company if there are specific acupuncture diagnosis requirements. Even if you've met all 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. Still, very few insurance companies will consider acupuncture medically necessary for treating viral infections like COVID-19 or bacterial infections like Rocky Mountain Spotted Fever, as there is little established research evidence that acupuncture helps treat these conditions. Also, most health insurance plans do not cover acupuncture for fertility enhancement, as they consider this “experimental” and medically unnecessary.
Although extensive research indicates acupuncture is especially effective at treating anxiety, infertility, and skin disorders, most insurance carriers also consider acupuncture to be “experimental” for treating these conditions. As such, they do not provide coverage for these diagnoses. Not all insurance companies will provide this 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 must jump through the same hoops as 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, conversely, don't pay premiums to health insurance companies and, as a result, have less recourse.
There have been occasions where we have been told that Silverlake Acupuncture was in-network and that the diagnosis was covered by the plan, only to have the claim denied because the insurance agent was mistaken or incompetent. In these cases, financial responsibility for all past acupuncture visits falls on the patient.
Tips For Ensuring Health Insurance Coverage For Acupuncture
At the end of a conversation with your health insurance provider, 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. The phone call ID may be 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 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 dissatisfied with your service or policy. By taking responsibility, we can help improve the system for everyone.
What Acupuncture Treatments Does Your Insurance Plan Cover?
Sure, your policy lists acupuncture coverage, but what does it cover? Does it limit the number of annual visits or exclude certain treatments or modalities? Then, there’s the issue of co-payment amounts and deductibles.There are a lot of questions, and Silverlake Acupuncture can help to a point. But ultimately, you’re better positioned to get these answers than we are. Calling us and providing us with your group number won’t enable us to tell you with certainty that our acupuncture services are covered.
Call Silverlake Acupuncture, An Acupuncturist That Takes Oscar
Silverlake Acupuncture is an acupuncturist that takes Oscar health insurance. If you have health issues that acupuncture can treat, and if you have health insurance that covers acupuncture, especially Oscar, Cigna, or Cigna+Oscar Health Insurance, then use the tips above to contact your health insurance company to verify the specifics of your coverage. Then, call Silverlake Acupuncture at (323) 662-6560 or click here to make an appointment.