What to Do When Insurance Companies Won't Pay
by the National Acupuncture and Oriental Medicine Alliance
When patients report their insurance policy will not cover acupuncture, there are several actions you can take.
1). Make sure you are asking the right question. Even within the same company, policies may differ. A policy may pay if acupuncture is recommended by an MD, performed by an MD, performed by a licensed acupuncturist, performed by an approved provider, when medically necessary, only for the treatment for pain, etc. You or your patient should provide the correct policy number and ask if acupuncture is covered under this policy. If it is covered, ask under what circumstances it is covered and whether there are any limitations or stipulations such as the number of treatments and/or conditions covered, who must perform the treatment, etc. Take notes and get the name of the person providing the information. Ask that a copy of the provisions regarding acupuncture be sent to you and/or the patient in writing.
2) Make sure the information is correct. Frequently employees are misinformed. If the employee is vague, insist that someone more knowledgable be consulted.
3) You or your patient, or both, may write a letter to the insurer. If so, send the claim with a cover letter that includes:
4) You may wish to file a complaint with the state insurance commission. In many states the insurance commissioner is an elected official who must stay in touch with public demands.
5) Consider sending a copy to your legislator and ask if he/she would be interested in sponsoring a parity bill so that consumers in your state can enjoy the benefits available in other states.
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