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.