In-Network Acupuncture Benefits Via Health Insurance
Health insurance is an intentionally complicated system here in the United States. As we’ve navigated and worked with insurance plans for the past 7+ years, below is a couple of topics in regards to Insurance Terminology, Medical Policies regarding Acupuncture, Coverage, and examples of Coverage. At the end of the day, your insurance benefits are your responsibility as a patient. Your employer, human resources department, benefit department, or your insurance broker are the ones that you should contact if you have questions about your coverage.
All costs for services rendered at Box Acupuncture will go to the patient, in the event that coverage lapses, changes, or if the health insurance benefit for whatever reason is not covered.
Health Insurance Terminology 101
Health Care Premium - this is the cost that the patient pays monthly to pay for their health insurance, this may also be deducted from your paycheck if your health insurance benefits are sponsored by your employer, job, or occupation. This is usually a fixed monthly cost, but can go up or sometimes down, depending on the benefits that you choose to receive. This is a topic that you would need to discuss with your employer or broker in regards to your general cost per month or year. Remember, that when you choose or opt-in to a health plan, that you’re in charge of choosing your benefits. Sometimes, employer-sponsored benefits that have acupuncture coverage are available, so you may want to consider asking your employer, human resources, benefit department, or insurance broker which plans have acupuncture coverage/benefits.
In-Network or Participating Provider - An in-network or participating provider, means that they have negotiated and signed a contractual agreement with an insurance plan and have agreed to accepting the cost of treatment by seeing a patient that has that health insurance plan. There are limitations to being an in-network or participating provider in that:
The health insurance plan can:
a. limit what procedures the participating provider can bill for based on the contract
b. limit what conditions the participating provider can bill for based on their medical policies
c. have extra procedures in place that the participating provider must follow in order to see the patient, such as requiring a Medical Necessity Review, Pre-Authorization, or Initial Evaluation separate from Treatment
d. may routinely audit medical records of the provider, choose to deny coverage, and ask for a refund for all services rendered - in the event that this does happen, the patient will be responsible 100% for all costs associated with treatments rendered
That being said, seeing an in-network or participating provider is often more beneficial for a patient purely from a financial point of view, often times costs are signficiantly less than that of non-participating or out-of-network providers. But it does depending on what is being treated, and what procedures need to be done.
Out-of-Network or Non-Participating Provider - An out-of-network or non-participating provider has not agreed to sign any contract with an insurance plan. That generally means that all costs for treatment are out of pocket or will need to be paid at the time of service. If insurance is being billed, often times out-of-network providers are allowed to “balance-bill” or charge the difference of treatment to the patient. In the event that we are out-of-network with your insurance plan, in order to simplify procedures, we will bill the patient up front, and any coverage or cost that the insurance does cover, the patient will receive a reimbursement check directly from the insurance company.
Deductible - this is the cost that you, the patient, must pay before your insurance begins to cover your medical treatment. Often