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All of this information is subject to change and is based on information currently available to us or from our interactions with the insurers in the past. Please confirm any of these details with your insurer before choosing your plan.
If coverage of acupuncture or our other services is important to you, please contact the insurer before purchasing your policy to ask about accessing them. While many insurers cover acupuncture and massage, you may still find it difficult or impossible to get them to cover your visits. Many insurers require pre-authorization of any visits you might want to use, may determine that you have received enough treatment before you feel the same, or simply not cover treatment of the condition you have.
Here are some particulars you may want to consider when shopping for your 2015 policy:
Aetna – Often will only pay for acupuncture if you have one of these medical conditions: Osteoarthritis of knee, osteoarthritis of hip, migraines, low back pain, nausea, post-op dental pain, chemotherapy side effects, TMJ disorder.
Cigna- Limits acupuncture coverage to these conditions: Tension headache, migraines, nausea, Osteoarthritis of the knee, neck pain, back pain, sciatica, and post-op pain.
Regence, Bridgespan, and Asuris – Require pre-authorization of physical therapy, acupuncture, massage, chiropractic, speech therapy, and occupational therapy. This authorization through Care Core National is necessary regardless of what your doctor might prescribe. Authorization must be done every 3-4 visits. For more info, please refer to this previous post.
Molina – We are not currently contracted with Molina. Authorization is required for nearly every service, chiropractic, acupuncture, and massage therapy.
Group Health – Acupuncture for most plans is done by self-referral. 8 visits are typically allowed without authorization, and more may be available with authorization. (Our chiropractor and massage therapist are not currently providers for Group Health directly. Some plans allow utilization of the First Choice network – for which both are contracted.)
First Choice – we participate in these plans. Coverage details are generally the jurisdiction of the employer, union, or primary insurance using the network. Please inquire as to your coverage and eligibility requirements with them.
Moda Health – utilizes the First Choice network. Per their website, they limit coverage for acupuncture to only: Nausea, post-op dental pain, TMJ syndrome, neck pain, back pain, osteoarthritis of the hip or knee, and migraine / tension headaches.
Coordinated Care – A new plan to Washington and we are unclear as to how they will handle our services.
United Healthcare – Our acupuncturist and chiropractor are both providers. United Healthcare is new to the individual market in Washington and we are not clear of how those policies will be administered. UHC has some limitations on diagnosis, but they have generally allowed access by self-referral. Some plans also allow for use of the First Choice network.
Premera and Lifewise – These two companies have generally liberal access to our services.
Community Health Plan – Utilizes First Choice network, appears to have no pre-authorization requirement. It is unclear as to any limitations on conditions.
Your insurance coverage will be changing in 2015
- Your deductible is likely renewing and will be due for all services in 2015
- Your 2014 eligible visits for massage, acupuncture, and chiropractic will end
- Flexible spending account monies will be forfeited
- Your access to acupuncture, massage, or chiropractic may change
Please keep this in mind when scheduling during the transition between 2014 and 2015!
Sarah Peters will be available for massage treatment Mondays, Fridays, and every other Saturday beginning Nov 1st, 2014. In addition to traditional massage therapy, Sarah is certified and experienced in craniosacral therapy. Currently, Sarah is not accepting insurance, but she is working on contracting as a preferred provider for a few insurances in the future. Massage visits with Sarah are currently priced at $60 per massage hour. Craniosacral Therapy is $70 per session.
Find more information about Sarah here -> Sarah Peters LMP
BBC Documentary – The Science of Acupuncture
REGENCE PATIENTS TAKE NOTICE: Regence to require pre-authorization of Acupuncture, Massage, and Chiropractic in 2014
REGENCE to require pre-authorization in 2014
Regence is beginning a program which requires providers to receive care plans from the insurance company. This change affects acupuncture, massage, and chiropractic care. It also affects physical, occupational, and speech therapy you might get elsewhere. This program will restrict your access to visits with us and our ability to receive reimbursement for care on Feb. 1st, 2014. At this point, this change will NOT affect those who are on Regence’s federal employee plans (FEP) or Uniform plans. If you have a question about whether this change will affect your plan, let us know or contact Regence.
Your treatment plan will be given to us by Regence and we are bound to it
The number of visits you may be allowed and the time line by which you need to receive them will be determined by Regence, regardless of any plan prescribed by your physician. For example, Regence may determine that you should be treated for 4 visits over 30 days. You would be required to come for all 4 visits in 30 days, or any request for additional visits may be denied. You would not be allowed to come for any additional visits until we get approval for them. Regence may also limit certain services it deems to be unnecessary to your care. We cannot collect any compensation from either the insurance company or you for any deviations from the plan. We will have to refuse you any treatments or services not approved during the course of your care plan.
Pain management will not be covered
If you have a condition that we cannot “fix” within a short time line (1-3 months), Regence will likely be refusing to cover ongoing visits. Many of our patients have osteoarthritis, fibromyalgia, herniated discs, and other types of conditions which will need some level of care indefinitely. Your semi-regular care here keeps you running and helps manage your pain. This type of care will likely not be covered. We will be allowed to do what we can for you in your initial care plan, but Regence will not cover routine care for pain management, preventative care, or “drop in” care. If you have another injury or complaint, or if you are re-injured, we will however be able to submit for another care plan to treat you.
All is not hopeless! You still have unlimited access to care
While your insurance may be limiting the number of your visits they will pay for, we are still available in unlimited quantities. If Regence refuses care for your condition, or you would like treatment beyond what was approved, we can create our own care plan! While having to go outside your insurance coverage is frustrating, it does allow you to get your treatments here, how you want them and when you want them.
If you have any questions regarding Regence’s new pre-authorization policies, please let us know.
CBS NEWS: Study finds that acupuncture effective for chronic pain.
Nice documentary on the ancient history of Chinese medicine and acupuncture by CCTV.
New National Institutes of Health (NIH) study find acupuncture helpful for treating chronic pain.
External link to video. http://youtu.be/WXeLgjZd6xk