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Alaskan Natural Care
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Insurance Information &
Verification
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We will need to check with your insurance provider to
verify if
acupuncture and/or myofascial release/trigger point (manual therapy) services are
covered. We will also
check the number of allowed visits, deductibles, and co-pays/co-insurance so
you will know your estimated share of charges are before your first
visit.
SINCE INSURANCE
INFORMATION CHANGES CONSTANTLY, WE WILL STILL NEED TO VERIFY THE INFORMATION BELOW!!
We no longer bill secondary insurance.
There are other companies
that cover acupuncture and manual therapies (myofascial release) other than the ones listed below, and we will need to check by calling them. You are responsible for all co-payments
and un-met deductibles at the time of service. Ultimately if
we are billing
for you and an insurance company refuses payment, you will be responsible for charges,
even when we have verified coverage in advance.
If they refuse payment, we will work with you on a financial arrangement.
Sometimes insurance companies that
don't normally cover services, will pay if you can prove you are saving them money, i.e.
reducing medications or avoiding surgery.* We have a letter available on request that
we can send to the insurance company on your behalf, encouraging them to cover acupuncture
services.
*(i.e. the State of Alaska will consider acupuncture on a
case-by-case basis, if you can prove you are saving the State money. This does not
include GGU and other bargaining units who are now covered under plans provided by your
unions/health trusts i.e. ASEA.)
Medical Necessity: This
does not mean that you need a doctor’s referral or supervision. It just means you
have to be treated for a legitimate medical condition, and they will not cover the
excluded items listed in your booklet, such as "stress", and for cosmetic
reasons. When we verify your eligibility for benefits, we have to tell them what
we are
treating you for, and they tell us if they will cover it.
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| AETNA
Alaskan Natural Care is a preferred
provider, but not all plans cover our services, and benefits
vary from plan to plan. We will need to call to check your
benefits. See specific plans below for details on some
plans. |
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ACS (Alaska Communications Systems)
Acupuncture is covered at 80%. No limit
on number of visits per calendar year, but Aetna may request
documentation of medical necessity after the 25th visit. |
| Anthem
Some Anthem insurance companies will honor Alaska Blue Cross
preferred providers for the preferred provider rate. We
will need to check with your insurance company. |
Auto Accidents (Personal
injury cases)
are usually covered, but we will need to check for sure and find
out your benefit limits, if any, and see if you need a written
referral from a doctor. We will only accept cases
where we bill the insurance company for you, unless you have
already settled your case. |
Alaska Electrical Health
and Welfare Fund (IBEW)
covers acupuncture for pain only. 2016: Covered at 85% until the
out-of-pocket amount of $2700 is reached, then at 90%.
Once out-of-pocket of $5400 is reached, then at 100%. No limit on the number of
visits. No medical massage/manual therapy benefits, unless supervised
by a chiropractor. |
| Alaska
Laborers Construction Industry Health & Security Fund
covers acupuncture. |
| Alaska
Native Tribal Health Consortium
covers acupuncture at 80% with 12 visits per year, and massage
with no limit to the number of visits, both at 80%. $200
deductible, until $1200 is paid out-of-pocket, then at 100%. |
| Anchorage Municipality
covers acupuncture at 80%, with a $250 deductible until $2000 is
paid out-of-pocket, then at 100%. No limit on number of
visits or other restrictions, but a Letter of Medical Necessity
is required after 20 visits. |
| ASEA Health Trust (State of Alaska
GGU bargaining unit) starting July 1, 2011, covers
20 visits per fiscal year (July 1) total for acupuncture, massage therapy,
and/or chiropractic appointments. 20% co-pay. |
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Blue Cross
(Alaskan Natural Care
is a Blue Cross of Washington and Alaska Preferred Provider)
All local Blue Cross plans are now covering acupuncture,
including the new Health Exchange plans.
(some State plans do not, i.e. New York). If
acupuncture is covered, medical massage/manual massage is covered through this office.
Some Blue Cross plans cover medical massage/manual therapy through an acupuncturist,
even if acupuncture itself is not covered.
Some employers/groups
include:
Alaska
Airlines (20 visits/year, 20% coinsurance)
Alaska Bar Association
(12 visits/year, $20 co-pay and then 100% of the maximum allowed)
Alaska Public Employees Association
(Details unknown)
Beacon
O.H.S.S
(12 visits/year, $25 flat co-pay)
Catholic Community Services
has
Blue Cross of California. They cover acupuncture for pain management only. (12 visits/year, maximum $25/visit, with a $15 co-pay, so they only cover
$10/visit)
Crowley
Marine Services - covers acupuncture at 80%, 12 visits/year,
with the deductible specially waived for this service.
FEP:
Standard
Option -
(2016) is subject to a $350 deductible, then
a 15% co-pay for acupuncture, or a flat $25 co-pay for
manual/massage therapy. Acupuncture 24 visits/year, manual/massage therapy 75 visits/year. Basic option
(2016)
- 10
acupuncture visits/year, 50 massage therapy/manual therapy visits/year.
Acupuncture and manual therapy/massage therapy are not
subject a deductible, and have a flat $30 co-pay.
Holland America
- has Blue Cross of
Washington. (12 visits/year, covered at 80%, $300 individual deductible)
Inland Boatman's
Union - covers acupuncture at 80%, 12 visits/year,
with the deductible specially waived for this service.
South Central Peninsula Behavioral Health allows 12 acupuncture visits and 45 Massage/Manual
Therapy appointments. Because we are in-network, your co-pay is 20%.
University of Alaska - allows unlimited
number of visits for acupuncture, covered at 80% until you have met your
out-of-pocket maximum, then at 100%.
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CIGNA -
It depends on the plan.
I no longer bill CIGNA due to
difficulties reaching their provider service agents, but I will
provide you with a bill you can submit for reimbursement from
your insurance company. |
Federal Express (Fed Ex)
insurance has covered acupuncture in the past. (20% co-pay, $150 deductible, no restrictions
other than conditions not allowed by your plan.) Current coverage
unknown. |
FEDERAL PLANS
The Federal Plans that we are aware of at this time that cover acupuncture are
Mail Handlers (see http://www.mhbp.com), Letter
Carriers, and FEP
(see above). All Federal employees have the option to elect these plans.
FEP
does cover manual therapy/trigger point
therapy/myofascial release/massage therapy through this office
(even though the plan says massage therapy is not covered, they
mean they do not cover massage therapists. Myofascial
release/manual therapy/trigger point therapy is what is
performed, which in insurance terms is not the same as massage
therapy.) |
| GEHA -
I no longer bill GEHA due to difficulties reaching
their provider service agents and difficulties getting payments
from the company as a provider, but I will provide you with a
bill you can submit for reimbursement from your insurance
company. |
Golden Rule
Golden Rule covers acupuncture. |
HEALTHCOMP
Usibelli Coal Mine (Healy)
- 24 acupuncture visits/year (any Naturopathic visits
also count toward the 24 maximum visits). Subject to $300
deductible. Coinsurance of 10%, amount unknown at this
time until the first claim is processed since Healthcomp could
not tell me the allowed charges. Non-network provider.
Massage and manual therapy are covered. |
| MEDICARE, Medicaid, and Denali Kid
Care
do not cover acupuncture or
medical massage. |
MERITAIN
(previously RBMS) has 50 different
plans, so coverage varies by plan. Our office will need to
call the insurance company for specifics.
Known Covered Plans:
Alaska USA Credit Union has a $100 deductible,
pays 80% of charges, has no maximum number of visits per year,
and requires medical necessity & verification of claim.
Kenai School District covers acupuncture and manual
therapy (performed by an acupuncturist) at 80%. Unlimited number of visits, as
long as medically necessary.
SouthCentral Foundation covers unlimited acupuncture
visits, and 30 massage visits with no referrals. Manual
therapy requires pre-authorization since the plan is "silent" on
that benefit.
YKHC
covers insurance that is "medically necessary." I will get a
list of conditions you want treated and submit a request for
predetermination of benefits for you. This takes at least 10
business days from the day I submit it. Benefits are covered at
80% after you have met your deductible. |
NEA ALASKA (Teachers,
except for Kenai Borough teachers)
are covered at 80% for both acupuncture and myofascial release, with a $100 deductible. You do not
need a referral from a doctor. Unlimited number of visits
per year. Starting 7/1/11, we
may need to submit a request for
pre-authorization to see if your treatments will be covered,
depending on the condition for which you are seeking care. Acupuncturists are under the EBMS definition of
"physician." Please call our office for
more information. |
State of Alaska Retired
(Wells Fargo) does not cover acupuncture,
but it will cover massage/myofascial release/manual
therapy with a referral from a health care provider. Call
for details.
State of Alaska Correctional Workers
- covers acupuncture, no limit # of visits, 20% coinsurance
(processed through Aetna) $350 deductible.
State of Alaska Laborers Union Local 71 Health Trust
- $300 deductible, 20% coinsurance, 16 visits per
benefit year (July 1 - June 30) acupuncture combined with
chiropractic visits (16 total visits between acupuncture &
chiropractic care). Aetna administers the plan for the
Health Trust.
ASEA Health Trust - see information near top of
page. |
| Teamsters (Alaska local)
- 10 acupuncture visits/calendar year. 20%
coinsurance, subject to $400 deductible. Massage/manual therapy
is covered when performed by a PT. |
UMR -
I no longer bill UMR due to difficulties reaching
their provider service agents and difficulties getting payments
from the company as a provider, but I will provide you with a
bill you can submit for reimbursement from your insurance
company.
Alaska Housing Finance - does cover acupuncture.
Pays at 90% after $100 deductible met, then 100% after $200
out-of-pocket met. No limits on the number of appointments
or benefit maximum.
MEA Electric - does cover acupuncture at
70%. No limit on number of visits, but does require
documentation of medical necessity after the 25th visit.
National Rural Electric Cooperative -
is covered 70% after the deductible is met.
Documentation of medical necessity is required after 25 visits.
Maximum 25 visits combined acupuncture, physical therapy, and
occupational therapy. |
United Healthcare has
several plans, so coverage varies by plan. I
no longer bill United Health Care due to difficulties reaching
their provider service agents, but I will provide you with a
bill you can submit for reimbursement from your insurance
company.
Wells Fargo Bank employees get 26
acupuncture visits/year, and 20 manual therapy visits, covered at
80% once your deductible is met. |
| VA (Veteran's Affairs) does
cover acupuncture with a VA doctor's referral, 10
visits/calendar year (possibly more upon physician's
recommendation), but Alaskan Natural Care does not accept TriWest/Open
Choice. If funding is available
directly through the VA (availability comes and goes), we will
accept VA patients. We will need to check funding availability
before scheduling your appointment.
As of 10/12/18 I have been informed there is plenty
of funding availability to go directly through the VA through
the fiscal year 2019. |
WORKER'S COMPENSATION
covers acupuncture and manual therapy/myofascial
release, and you will need to bring a doctor's written referral
to the office on the first visit. We will need to confirm coverage with the company prior
to your appointment, so be sure to tell us this is a Worker's Comp case.
You will want to check to make sure your case was opened. We are required to bill Worker's
Compensation for you. Federal Worker's Compensation
is not accepted due to issues with payments. |
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HEALTH CARE REIMBURSEMENT ACCOUNTS and MSA's:
These accounts allow you to set aside pre-tax dollars and use it to pay for
expenses your regular plan does not cover, such as deductibles, your co-pay amount, and
non-covered expenses such as acupuncture (allowed items are listed in IRS publication 502,
"Medical and Dental Expenses"). Medical massage is not
covered. The advantage is that you do not pay taxes
on this money (FICA, Medicare, and Federal Withholding). There is a maximum you can
contribute per year. The State provides their employees with this option,
and if you are self-employed you can set up an MSA through some insurance companies.
For the State of Alaska employees, you need to elect this option and state the amount you will
contribute during your open enrollment period (in May), then
that amount is deducted from your paychecks. (You have to elect a HCRA annually if
you want to be covered for the subsequent benefit year!) You need to
use-it-or-lose-it during the benefit year, but you can spend it before you have
contributed all of it (i.e., you can spend $500 in the first month, even if you have only
contributed $50 at that point). The State does not charge an administrative fee to
administer your HCRA account. For more
information, contact your Retirement and Benefits section.
For self-employed MSA's, the rules are different, in that
you can accumulate the unspent money and take it out after age 65 (like an annuity).
You contribute monthly amounts, but you may contribute additional amounts during
the year up to a maximum amount in lump sum contributions.
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