acupuncture and Health Insur. ?

[dreamin_disney]

Hello. Does anyone have Blue Cross and use it for acupuncture? My Dr. sent in a referral for it and it was dendied. She put for chronic pain and the letter said there's no insufficent evidence that acpuncture treat it.

How can I get the insur to cover it. What has your Dr. put to qualify you for it?

I have high blood pressure
infertility
I dont get a monthly cycle
headaches and cant take over the counter meds because otc med raise my liver enzymes due to fatty liver

pre-diabetic at times the bottom of my feet a lower legs hurt bad & sometimes circulation.

and bad constipation


I've been paying $25 for reflexology out of my own pocket(once in a while if i have the $$) and it helped so i know i will benefit from accupuncture but i cant pay $75 for it per visit especially if insur covers it it will on be a $10 co

I started eating healthing and walking and have lost 10lbs in 2 month .any advice on getting acupuncture medically approved. Thanks

 

[bumbershoot]

I've always just paid out of pocket for it, since I don't want to deal with a gatekeeper.

For you, I'd just keep having the doctor insist that it be covered...

I hope you can get in, b/c it really sounds like it would do you a world of good. That's a lot of funky systemic stuff, the stuff that's perfect for a good acupuncturist to work on!

Have you considered good, gentle "real" (not someone who advertises for "personal injury" cases in the Yellow Pages) chiropractic? They can help with those things as well; it's all about getting the body's systems to work better! Same with acu and reflexology, actually. Just different ways of going about it.

 

[arminnie]

Look at your stated benefits - it's either covered or it's not. My coverage is from working in California where accupuncture is more widely accepted. I get 50% coverage.

I've only had about 4-5 sessions to deal with pain and it has really helped. It is not a one size fits all fixes everything kind of treatment.

 

[Calliaz]

My BCBS plan covers it as part of my treatment at my chiropractor. Every plan is different, though. I can't just get acupuncture. I have to get an adjustment and acupuncture and I pay 2 copays.

 

[dreamin_disney]

my insurance covers accupunture. The insur person said I need to have the Dr. send in a referral with reason and how many session i would need so she did.
ok looked at the letter again and its been denied by the medical group not insurance

heres the letter

Dear " "

The requesting provider/physician has asked for the above referenced sevice. The service requested is being denied by "--------Mecial Group"
based on Milliman Care Guidlines Acupunture, there is insufficient evidence to determine the efficacy of acupuncture for treatment of chonic pain, therefor the current role remains uncertain and has been denied as not medically necessary. Please follow-up with your Primary Care Physician to discuss alternative treatment options and further direction.

You may obtain a free of charge copy of the actualo benefit provision, guidelines, protocol or simiilar criterion on which the denial was based on upon your request, by calling "------Medical Group at phne #"



I'm confused why the medical group would deny it and not the insurance. The Dr. was all for me doing acupunture. I also have a hormone imbalance PCOS so I'm a hot mess! Do i call the medical group, call the Dr. or my insurance???? It also says i can dispute it by filling out a grievance. The Blue Cross insurance worker said i have coverage i just need to have a referal and how many visits i would need and it would have to be an acupunture thats recommend through the medical group

 

[Deesknee]

Most insurances have many different plans. If you call the 800 # you'll notice the recording usually says is if you work for so & so press 1, if you are a federal employee press 2, if you work for so & so press...... you get the idea. Some health insurance companies offer hmo vs non-hmo. The benefits MAY differ, as MAY copays etc. If it were me, I would call the # on my insurance card ask how I could get a copy of my benefits & ask the customer service rep if you have acupunture benefits. Then when you get your copy (some insurance companies have benefit brouchures online), verify the info you recieved from the customer service rep. If you have benefits, call a cs rep & ask what you need to meet medical criteria. Then ask your physician if you qualify as stated by medical neccessity & have him put in writing if applicable.

Best of luck. My insurance didn't pay for acu. I had to pay out of pocket. And, it didn't work in the end. I have heard wonderful things about it though, for many many issues.

 

[Hannathy]

You may obtain a free of charge copy of the actualo benefit provision, guidelines, protocol or simiilar criterion on which the denial was based on upon your request, by calling "------Medical Group at phne #"



QUOTE]

First things first Did you do this? Did you get the guidelines on why it was turned down? It sounds like there is a protocal that has to be followed before they will approve and possibly your DR skipped a step so they feel they haven't tried everything else. OR your DR put down a diagnosis code or symptom that didn't match the way it needs to be written too allow acupuncture. It may be as simple as your DR called it light purple and the insurance needed it to be written as lavender. or you need diagnosis code 656 and he called you 655.

I would start with getting from them why you were turned down and seeing if you and your DR and figure out how to write it so you can get it if possible.

 

[dreamin_disney]

Thanks for the info I just got the letter so i will make calls nextweek. I told dh usually when a medication has been denied the insurance will send us a letter. Dh also thought it was strange that the denial wasfrom medical group. I will look into it but our medical does have acupunture coverage.

 

[crisi]

I used to work for a big insurance company. They did statistical data analysis on accupuncture and chiropractic and only covered it if there was a statisically significant chance accupuncture or chiropractic would help (I did the business analyst job on installing the software they used). And if it didn't, we sent out a letter that looked a lot like that.

Your insurance company doesn't think it will help and won't pay for it. You'll need to pay for it out of pocket.

 

[dreamin_disney]

I used to work for a big insurance company. They did statistical data analysis on accupuncture and chiropractic and only covered it if there was a statisically significant chance accupuncture or chiropractic would help (I did the business analyst job on installing the software they used). And if it didn't, we sent out a letter that looked a lot like that.

Your insurance company doesn't think it will help and won't pay for it. You'll need to pay for it out of pocket.

hhmmm darn it lol! now i'm wondering what it will cover

 

[DawnM]

Mine won't cover it unless you have arthritis.

Dawn

 

[crisi]

hhmmm darn it lol! now i'm wondering what it will cover

You can appeal, but I don't know you'll get very far. Its been several years, but when I was working on that project, we'd cover only several sessions of acupuncture for things like pinched nerves - where acupuncture had a good success rate. Of the things you listed, the only one that we'd have had a chance of covering acupuncture to treat is the headaches, and then only short term - a few sessions.

 

[zumbergc]

You might need to find out what diagnosis your doc put in the letter for why you need the acupuncture. Also, find out what codes your insurance will pay for. Then make sure the codes for what your insurance will pay for in on the referral.

I goto a acupuncturist. I pay out of pocket. Pretty much one flat fee. Doesn't matter if he puts in 10 needles or 40, same price, same time.. so if the treatment for your insurance is one of your problems you have... you just have to get that code for the insurance to pay. However, the acupncturist can treat several things at once.

 

[IndayMichelle]

I work at a clinic with an acupuncturist. Some insurances just do not cover it. Regardless of how insistent your doctor is, they may not cover it.

Some insurances do not cover acupuncture by a licensed acupuncturist, it has to be performed by an MD. Crazy right?

Others only cover it for certain diagnosis codes. Most of the time you have to ask the insurance rep about specific codes. They don't always disclose information unless you are very clear about what you need from them.

As far as infertility, we have a practitioner who does acupuncture and maya abdominal massage together in 1-hour sessions. You might find someone who will do both and bill massage codes only. It just depends....

Good luck to you.