One of my patients is switching insurance policies and asked me which one she should choose to get the best acupuncture coverage. I get this question from time to time, so decided to write a blog about it. Below is a list of questions to ask your insurance agent when choosing a policy:
- Does this policy offer acupuncture benefits?
- Are there any diagnosis exclusions? Some policies state that acupuncture is a covered benefit, but when you read the fine print you may find that acupuncture is only covered “in lieu of anesthesia” or some other extreme limitation that makes the coverage of no use.
- Does the policy cover out of network providers? Stillpoint is not contracted with any insurance carriers, and so you must have out of network benefits in order to receive benefits for care from our clinic.
- What is the deductible?
- What is the limitation for the number of visits or dollar maximum coverage for acupuncture? Is that maximum combined with chiropractic and/or physical therapy? Also, it is important to know whether count toward the maximum benefit kicks in immediately or after the deductible is met. Because, if you have a maximum of 10 visits covered per calendar year and a $1500 deductible, but the count toward the maximum starts right away, you won’t get any benefit because all ten visits will just apply toward your deductible and your coverage will be maxed out.
- What are the allowed amounts of coverage for acupuncture? The answer you want to hear on this one is “Reasonable and Customary,” meaning that the policy allows for charges up to the going rate for those services in your area. Often times, allowable amounts are only $30 or so, which, while somewhat helpful, is not ideal.
- What is the copay or co-insurance? Co-pay is a fixed-dollar amount that you pay each time for certain services. Most commonly, you will be responsible for a co-payment for each visit. For example, you may pay a $15 co-payment for a primary care physician visit and a $25 co-payment for a specialist visit. Co-insurance is a percent of the cost of your care. You are responsible for paying the co-insurance amount. For example, if a doctor’s visit is $100 and you have a 20% co-insurance, you will pay the doctor $20 and your health plan will pay the doctor $80.
I think that covers it! If you have any further questions about choosing a health insurance plan, please feel free to call our office and we will do our best to help.