Happy Open Enrollment Season!

Picking an acupuncture-friendly policy

It’s open enrollment season and you know what that means: it’s time to make decisions about your 2020 insurance coverage!

We get a lot of questions about which plan you should pick to get the most of your acupuncture benefits. Truth is we really don’t know sometimes! We’re going to do our best to share with you what we know from our years of experience.

All practitioners at Pekoe are in-network with Blue Cross Blue Shield (BCBS for short) and many of you have the BCBS Federal Employee Program (FEP) policy. Much of the information listed here will refer to BCBS and BCBS FEP policies. As for other plans and BCBS benefits, you’ll have to either call customer service (see: Useful q’s below!), or check your handbook. There are some tricky plans out there, so we encourage you to dig deep if you really want those acupuncture benefits!

While we try to stay as up-to-date as possible on our insurance knowledge we recommend you visit the or the Blue Cross Blue Shield Federal Employee program handbook for the latest and more accurate policy information about this particular plan.

While all of our practitioners are in-network with BCBS one of our practitioners, Noah Samuels, is also in-network with United Healthcare, Aetna, and Cigna. If you book appointments with a practitioner who is not Noah and you would like to use a United Healthcare, Aetna, or Cigna policy to cover your visit we will still submit your claim to the insurance company as “Out of Network”.

There are so many different plans out there, but we do know a few tidbits off the top of our heads…

The Foreign Services Benefits Plan offers the following:

  • $40 copay for acupuncture
  • Massage coverage $60/session: We would have to provide a superbill for you to submit for reimbursement. Keep in mind, you would pay the out-of-pocket amount for the massage at the time of service and upon submitting the superbill we provide, you would receive reimbursement from your insurance company at a later date.

The BCBS Federal Employee Program Standard Plan offers the following:

  • $350 deductible + 15% co-insurance
  • 24 visits per year
  • The out of pocket for individuals is $5000. The out of pocket for families is $10,000. Once this out of pocket is met you would pay $0 per visit.

The BCBS FEP Basic Plan offers the following:

  • No deductible
  • $30 copay
  • 10 visits per year

The BCBS FEP Focus Plan offers the following:

  • 10 visits per year between acupuncture and chiropractic combined.

Some BCBS Plans state “discount program”, which we do not participate in. Check with customer service to see if you have acupuncture benefits.

Kaiser only covers acupuncture visits in their own facilities. We are not a facility of Kaiser so there would be no coverage for a Kaiser policy.

Medicaid/ Medicare do not offer coverage for acupuncture. We would bill directly to the secondary insurance plan.

Again, other BCBS plans vary and of course we can always accept out-of-network benefits for all other insurance companies. Of course, once you’ve selected your plan, you can use our insurance eligibility tab to verify benefits through our insurance biller.

What are some keywords or questions?!?

Since we don’t know all the plans, you might want to confirm with your potential plan before selecting which one you want. Before calling, please remember: You will want to pack a book or other entertainment for your trip because insurance companies are not afraid to put you on hold. Anticipate a 20 minute wait, and if it takes less time than that you can do a little happy dance!

Now here are the handy questions you can ask your insurance provider about your policy:

  • Does my policy offer acupuncture benefits?
  • If my policy does offer acupuncture benefits does acupuncture need to be given by a physician, or a licensed acupuncturist?
  • Are there any limitations or exclusions to my acupuncture coverage? (For example, some policies only cover acupuncture if the treatment is addressing physical pain.)
  • What is my deductible?
  • Does my deductible apply to the annual visit limit?
  • What is my copay/co-insurance for acupuncture?
  • Is there an annual visit allowance for acupuncture?
  • (If not BCBS) Do I have out-of-network coverage for acupuncture?
  • Do I have massage benefits?

Pro Tip: If your plan states “For use for anesthesia only”  means that you probably do not have acupuncture benefits. This is for acupuncture for anesthesia before surgery, which isn’t really a thing here in DC…. (If you find that doc, I would like to meet them.) Sometimes you can get benefits for “acupuncture for anesthesia” if you have pain, but you’ll have to confirm with your specific plan first. Unfortunately, with some of these plans, no one is ever sure until we get the check and Explanation of Benefits.

What questions/comments do you have for our insurance questions list? Let us know if you think we should add anything!

Our next blog is about your FSA account and how to get the most of our your FSA money before the end of the year! Hint: We recommend you treat yoself! Stay tuned for the next blog post and a list of goodies you can use your FSA account to cover here at your favorite neighborhood wellness center!

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