We do direct billing for:

• HCHP , Blue Cross, Tufts Health, and Mass General Brigham, for plans which have In Network acupuncture coverage benefit
• *United Health Care, *Aetna, *Cigna, and any other plans for which we can verify Out Of Network acupuncture benefits  (*We are out of network with United Health, Aetna and Cigna. The Cigna plans which partner with Tufts we are generally in network with)
• Auto accidents
• Veterans referred through the VA Medical center with preauthorized visits.

We are all on the panel for Harvard Pilgrim, Blue Cross Blue Shield, Tufts, and Mass General Brigham Healthcare, for those with acupuncture benefits.

A NOTE ON Medicare:

Medicare only covers acupuncture for chronic low back pain and ONLY when performed by a Medicare contracted physician (MD).  They do not recognize licensed acupuncturists as providers at this point.  Medicare supplemental plans, even those that say they cover acupuncture, are subject to the rules of Medicare and only cover costs not covered by Medicare. We are not Medicare providers and are not currently eligible to be Medicare providers. 

A number of insurance plans with acupuncture coverage will reimburse providers who are not in network.  Once we have verification of your coverage details, we will inform you of the benefits and restrictions.  If we are out of network with your insurance company, we do not know until we receive a payment what they will reimburse for our services.  While most often the reimbursement amount is acceptable without additional charges to the client, there are times when what is deemed “reasonable and customary” is way below our fee.  When this happens, the patient is responsible for the balance of the fee. 

Therefore, we require patients to keep a credit card on file in the event that we do not get paid at least our regular fee, including your copayment.  We don’t charge without contacting you first to make sure that you are fully aware of the details.  It is very important to us in our relationship with our clients that financial problems or disputes are handled in a way that feels honest and respectful up front.  Thanks for understanding and appreciating this policy.

Insurance billing is a service that we provide to make it easier for you to access acupuncture services, and we are happy to do so. There are costs associated with billing the insurance companies on your behalf that we absorb to provide that service.

We ask that you be mindful of the fact that when a patient late cancels with less than 24 hours notice, or doesn’t show for an appointment, we are not able to bill the insurance company for that time. For this reason, insured patients are held to the same financial policy that we have for all of our patients.

Should you late cancel or miss an appointment, without a reasonable emergency, you will be responsible for the cost of the visit in full. We deeply appreciate your understanding of this policy.

When it comes to insurance billing, it is common for patients to struggle with understanding how their coverage works, especially deductibles.  Many people have high deductible plans, and other than predetermined preventative services (annual visit, mammogram, colonoscopy, etc) most charges will apply to your deductible until that amount has been spent out of pocket, at which point, your insurance will being paying for covered services under your policy.

This is the contract that you agree to when you get an insurance policy.

 By law, the insurance deductible is the patient’s responsibility, this means that if you choose for us to bill your insurance, the amount that the insurance company applies to your deductible will be the amount that you will owe our office in order to satisfy your part of the contract with your insurance company.

This happens with any medical provider who bills your insurance for a covered service.

While we have a discounted cash rate for our patients who do not have insurance coverage, billing insurance has some different rules.

When we submit a bill, we are required to submit the individual procedure codes for the services we provided during the visit, and these codes must match our treatment notes for the date of your service.  When this is done, the billing company attaches a predetermined fee for each code, which is why the bill may look higher than it would if you were to pay the discounted cash rate.  This does not mean that we get paid that amount, but we do get paid the amount that the insurance company approves for each code, less your copayment. 

If your deductible is on the lower end, somewhere between $600-2500, and you know you will need some ongoing treatment and would like to use that benefit, it might be worth submitting the bills to pay down the deductible.  It is important to understand that billing towards your deductible will also count towards your covered visit limit.

It is your responsibility to pay our office any amount that is applied toward your deductible.

Your Choices:

 1. We will happily bill your insurance directly to satisfy your deductible and once the deductible is met, as long as we have a signed financial agreement and a credit card on file with permission to charge you for any amounts applied to your deductible once a claim is processed.

OR

2. We can supply you with proof of payment at our discounted cash rate, along with a detailed bill to submit to your insurance company until your deductible is met.

*Remember, FSA and HSA plans can be used to pay for any amount applied to the deductible and for copayments and cash payments.  We are happy to supply you with any information the might be requested to prove payment.

Please let us know what your preference is when we discuss payment and billing.  We hope you can understand and appreciate that it isn’t sustainable for us to do this any other way.

Experience our fully personalized care programs that fit into your schedule and help you find balance.

or call us: 508-435-8184