Our office loves to help people use their insurance coverage!
Functional Medicine visits: we can bill PPO plans for an office visit, however, coverage is all over the place. We ask that people pay at the time of service, and when we bill if there’s any reimbursement we will promptly give you a credit or a refund.
Acupuncture visits: we are pretty familiar with what local plans pay, and we’ve outlined this below. We can only bill PPO plans and Aspire plans, so if you don’t have one of those, we cannot bill for acupuncture (or functional medicine). We always keep your credit card securely on file, for insurance copays and in the event they don’t pay at all (we give a heads up before charging your card!). It’s best if you verify coverage in advance.
Unfortunately, we are not a Medi-Cal provider at this time. There may be other local practitioners, or perhaps in Watsonville or Santa Cruz who are. Five Branches Institute in Santa Cruz where Laura attended school has practitioners that do bill Medi-Cal in their clinic.
Medicare and Tricare
These are federal programs that do not cover acupuncture, unfortunately. Recently Medicare is allowing 12 visits per year for chronic low back pain, and we are able to use those visits for people on Medicare who have Aspire as their secondary.
Aspire secondary to Medicare
Acupuncture is fully covered with no co-pay. The number of visits per year depends on the tier of Aspire that you’re enrolled in. In addition, you can also take advantage of an additional 12 visits for chronic low back pain, and these visits must take place within 90 days, so roughly one visit per week. Most people plan these visits when they are in town for three months. We can treat other things during these visits in addition to chronic low back pain.
Aspire (a.k.a. Coastal) Chomp employees
Chomp employees with Aspire have a $25 copay and an additional $35 fee for codes billed that Chomp’s Aspire does not cover (They only cover 15 minutes of acupuncture and we provide 45-60 minute treatments.) Your total payment is $60 per visit.
Aspire (a.k.a. Coastal) Salinas Valley Memorial employees
A referral is required and you must have it in hand before your first visit – no exceptions. Then, acupuncture is fully covered for 24 visits. If treatment is needed beyond 24 visits an authorization will need to be obtained thru Aspire.
Anthem MPC employees
Acupuncture is fully covered, with six visits per diagnosis code and unlimited visits per year.
Anthem MIIS employees
Acupuncture is fully covered, with unlimited visits. This plan will also reimburse for office visits for functional medicine!
Anthem CALPERS plan (CSUMB, state and county employees)
Typically acupuncture is covered about 90% after a $500 deductible is met. The remaining amount tends to be about $11 per visit, and we keep a card on file to charge the small amount due after we receive the statement from insurance.
Blue Shield MCSIG plan
Local teachers under MCSIG get $2000 per year to spend on acupuncture (roughly 20 visits). However, your Blue Shield plan reimburses you directly, they don’t reimburse us. This means that you pay at the time of service, we send in the billing electronically at the end of the week, and within a month you should receive a reimbursement check.
All Blue Shield plans
Blue Shield covers well for the Federal employee plan (FEP). Any other Blue Shield plans must be a PPO for us to submit bills. All Blue Shield plans reimburse you directly, they don’t reimburse us. This means that you pay at the time of service, we send in the billing electronically at the end of the week, and within a month you should receive a reimbursement check (if you have coverage).
We can only bill Anthem PPO plans. If your plan is not one of the above, you can send us a picture of your card and we can tell you if we are familiar with your plan and what we estimate the coverage is. If we are not familiar, you can contact your plan and ask if there’s coverage for out-of-network acupuncture, and if a deductible applies (if so, how much is the deductible). This will help us estimate what the coverage is. Many Anthem PPO plans have good coverage for out-of-network acupuncture!
In our 20 years of billing United, we have rarely seen them pay. People with United (PPO only) must check their coverage. Ask if there’s coverage for out-of-network acupuncture and if there’s a deductible. Ask how much your plan pays for acupuncture. Then let us know and we can decide whether or not we will bill. To be honest, we are skeptical about United covering. If it’s a really good United plan, it’s a possibility.
Cigna and Aetna
These are not common plans in our local area, however, occasionally people have these plans with excellent coverage for acupuncture. You need to ask your plan (PPO only) if there’s coverage for out-f-network acupuncture and if a deductible applies.