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Most Health Insurance Plans Cover Acupuncture Care

Many insurance companies now offer policies that cover acupuncture and related services, such as acupressure therapy, far-infrared heat treatments, and etc. performed by a licensed acupuncturist. This ongoing trend is that acupuncture coverage is becoming more commonplace with California health insurance plan. In general, health plans have quickly moved towards more preventative health care and alternative health care costs. Acupuncture is usually grouped under the "alternative health care" banner with chiropractic. However, it has become the mainstream both in terms of use and as a matured and licensed means of medical care simply because of its safe and economic efficiency in treating many chronic conditions and preventive health care.

Since the underlying issues that require acupuncture care are typically more chronic in nature (last long periods of time if not indefinitely), there may be caps on the number of covered benefits in a given year. The actual covered acupuncture and acupressure benefits also depend on the health plans you selected.


Many Health Insurance Provide Acupuncture and Acupressure Benefits

PPO Plan (Preferred Provider Organization) - gives you the freedom to visit any provider who's right for you. You don't need to choose a primary care physician (PCP) and you don't need a referral to see a specialist such as an acupuncturist like us.

HMO Plan (Health Maintenance Organization) - requires that you select a primary care physician (PCP) who is responsible for managing and coordinating all of your basic healthcare services. If you need care from a physician specialist like us, your PCP will have to provide you with a referral. If you do not have a referral or you choose to go to a doctor outside of your HMO's network, you will most likely have to pay all or most of the cost for that care. Many practitioners do not participate in health carrier networks. Unfortunately, many practitioners do not participate in health carrier networks. Therefore, your selection to visit specialists is very limited.

EPO Plan (Exclusive Provider Organization) - is a mix between an HMO and a PPO, except that it only allows you to see physicians that are in the EPO's network, unless it is an emergency. However, for acupuncture care, some EPO plans allow patients to see acupuncturist outside the network. If you have EPO plan, please call us to verify your acupuncture benefits.

POS Plan (Point of Service) - is similar to an HMO. You are required to designate an in-network physician to be your primary health care provider. You may go out-of-network if you choose, but in doing so, you will have to pay most of the cost yourself, unless a primary care physician refers you to that specific doctor.

We accept most major PPO and EPO health insurances. Filling out Insurance Verification Form online will enable us to verify your benefit and eligibility for treatment with your insurance company. We will normally verify your insurance within 24 hours on regular business days. After verification, we will contact you to set up an appointment.

General Guide - Benefits and Coverages
Plan Requires PCP Requires Referrals Pays for
out-of-network care
Acupuncture
Benefits
PPO No No Yes Yes
(most plans)
HMO Yes Yes No No
EPO No No No Maybe
(need to check)
POS Yes Yes Yes
(requires PCP referral)
Maybe
(but requires PCP referral)
 
Covered California Insurance Plan

Covered California health plan includes coverage for acupuncture.  Under the Affordable Care Act, each state selected a benchmark plan and all the benefits included in the benchmark plan are considered


Covered California Plans
include acupuncture benefits

“essential health benefits”.   Essential benefits vary from state to state, however cannot include annual and/or lifetime dollar maximums.

In California, acupuncture  is an essential benefit and must be covered by individual health plans to comply with federal and state law.  This means that your health plan cannot deny you treatment for acupuncture care as long as it is for treatment of nausea or as part of a comprehensive pain management program.   As long as you can show that acupuncture is medically necessary for your condition, there are no annual limits on the number of visits you can receive.  You should only pay your standard primary carevisit co-pay when you seek care, for example $45 on a Silver plan.

Health Saving Account (HSA)

HSA (Health Savings Account) - is a tax-advantaged medical savings account available to taxpayers who are enrolled in a high-deductible health plan (HDHP). The funds contributed to the HSA are not subject to federal income tax at the time of deposit. You can use it to pay for qualified medical expenses at any time without federal tax liability or penalty. We are the qualified physicians accepting HSAs.

Flexible Spending Account (FSA)

HSA (Flexible Spending Account) - also known as a flexible spending arrangement, is similar to an HSA to pay for qualified medical expenses (but not insurance premiums), except that it is set up and owned by your employer. You can only deposit money into your FSA through payroll deduction, which is not subject to payroll taxes, resulting in substantial payroll tax savings. Employers may make contributions to your FSA.

Some employers let you carry up to $500 into the next year. Otherwise, any money left in the account at the end of the year goes back to your employer. We are the qualified physicians accepting FSAs.

Auto Insurance Covers Acupuncture After Accident

If you are unfortunately involved in an automobile accident and hurt, the most important thing to do is to seek immediate medical attention. Many people think their injuries or conditions are minor or even nonexistent. Only later they discovered they had received major, lifelong damage and trauma. In addition, your failure to seek immediate medical attention will be used against you by the insurance companies and their lawyers, who will argue that you would have sought medical treatment immediately after the accident if you had been seriously injured. However, all these are usually avoidable if you get proper early treatment.


Auto Insurance
Covers acupuncture care

There have been a number of recent studies indicating that auto injury victims with soft tissue acute and chronic pain derive more relief and faster recovery with acupuncture and associated therapies than other commonly used therapies. And, because of this, Auto Insurance Adjusters are becoming more responsive to the faster and more complete recovery from Acupuncture than these other therapies.

Our acupuncture and acupressure treatments are covered by "PIP" (Personal Injury Protection) and Med Pay of your auto insurance policy. Call your insurance company and speak to the individual managing your claim. Inform them of your interest in receiving acupuncture care for your injury. Let us know your claim number when you come to visit us. Our team of specialists of auto injuries, are here to guide you to the appropriate treatment program which includes injury evaluation, acupuncture, medical massage therapies, ultrasound as well infrared and other examinations and treatments when necessary. We will submit the medical claims to your insurance company or the third party insurance company directly. Your cost is nothing. We are the qualified physicians accepting auto insurance.

Acupuncture Is Covered by Workers' Compensation

WC (Workers' Compensation) - is a state-mandated insurance program that provides compensation to employees who suffer job-related injuries, such as falls and cuts, and illnesses related to cumulative trauma, for example, carpal tunnels. In general, the employees can get workers' compensation benefits regardless of who was at fault. In exchange for these guaranteed benefits, employees usually do not have the right to sue the employer in court for damages for those injuries.

There are generally two categories of work injuries, namely acute and chronic:

  • Acute injuries - One event at work: Examples: hurting your back in a fall, getting burned by a chemical that splashes on your skin, getting hurt in a car accident while making deliveries.
  • Chronic injuries/illness - Repeated exposures at work: Example: a software engineer who sits in a chair in the wrong position without taking frequent breaks may put enough strain on the back muscles to cause chronic back aches or carpal tunnel syndrome.

Workers' compensation covers some, but not all, stress-related (psychological) injuries caused by your job. Also, workers' compensation may not cover an injury that is reported to the employer after the worker is told he or she will be terminated or laid off.


Carpal Tunnel Syndrome

Acupuncture is covered under California Workers Compensation law. The acupuncture guidelines state, in part:

  • Neck and Upper Back Complaints
  • Elbow Complaints
  • Forearm, Wrist and Hand Complaints
  • Low Back Complaints
  • Knee Complaints
  • Ankle and Foot Complaints
  • Pain, Suffering and the Restoration of Function

What to Do if a Work-Related Injury, Illness Occurs

  • Notify your supervisor immediately. If your injury or illness developed gradually, report it as soon as you learn or believe it was caused by your job. If you don't report your injury within 30 days, you could lose your right to receive workers' compensation benefits.
  • Get emergency treatment if needed.
  • Get first aid and see a doctor if you don't need emergency. You can predesignate a doctor of medicine (MD) or doctor of osteopathy (DO) who treated you in the past and has your medical records. You may prepare your own written statement, use optional DWC Form 9783 provided by the state Division of Workers' Compensation, or use a form provided by your employer. Although you cannot predesignate your personal acupuncturist like us, you can switch to us upon request your employer after you first see a doctor chosen by a claims administrator (a person who handles workers' compensation claims for your employer).

As Qualified Medical Evaluators (QMEs) who are certified by the California Division of Workers' Compensation Medical Unit, we have successfully treated many injured patients since 1994. If you need additional assistance or have any questions, please contact us at 408.524.0676.


Acupuncture
Mon. ~ Fri.: 10am - 7pm
Sat.:     9am - 1pm
Sun.:   Closed