1. "What is the normal co-pay for acupuncture?" (This is the amount you would pay out-of-pocket for each visit to a practitioner on their provider list.)
2. "What percentage will you pay for out-of-network practitioners?"
   

Make sure that you also understand the amount of your deductible. Although I am not listed on your provider list, I can often accept your co-pay fee plus the percentage your plan pays non-participants. In other words, I will do all that I can do to make it financially stress-free for you to work with me if you choose to.

If your insurance plan does not cover an 'out-of-network provider' (me), and you chose to work with me instead of with a 'preferred provider', it will cost you aproximately $25 more per session.

Why would you want to do that?
I can think of at least three reasons:

1. Treatment Techniques

Acupuncture is about much more than pins and needles. "Zhen Jiu", the Chinese word for acupuncture, means needle and heat therapy. Japanese direct moxa heat therapy is a significant part of my practice, and is not allowed by insurance companies. Several other Japanese techniques are also not covered.

2. Confidentiality

When your doctor visit is payed for by insurance, that visit goes permanently into your medical records. When you pay me directly, no one outside the two of us, including your current or future insurance carrier, ever needs to know that you are seeing me, or what you you are seeing me for. Also, we can talk privately about anything and everything that might be on your mind. This can be helpful because Chinese Medicine doesn't separate emotional, mental and physical complaints. Considering all aspects of your health is often the best way for me to form a complete picture for finding the best treatment plan for you.

3. The Freedom to Address All of your Concerns

Your insurance plan only covers acupuncture for conditions of pain. But in addition to any kind of acute or chronic pain, acupuncture is an effective approach for allergies, auto-immune conditions, irregular menses, flu, insomnia, late delivery, and dozens of other conditions acknowledged by the World Health Organization. "Preferred providers" are not allowed to focus treatment on any of these concerns. Many practitioners do choose to bend the truth on their insurance forms, but 16 years of practice has convinced me that effective patient care is dependent on honesty and trust. I am not comfortable introducing half-truths into my practice.

For even more revealing thoughts on health insurance and my practice, read on... (or at least skip to the amusing finale - "Quick Tip of the Week")

1. There would be imposed limits on what conditions I would be allowed to treat. Generally, only pain conditions are covered for acupuncture. This shows ignorance and disrespect for the holistic and widespread application of acupuncture, and invariably leads to practitioners lying on their patient records in order to be reimbursed. All non-pain complaints are left out of the notes. This is a sticky situation, with all options a bit distasteful.
2. I would be prohibited from doing direct moxa – a technique of major importance in my practice, and an extremely effective home self-care technique. I use other prohibited techniques as well.
3. Many many people would read and have access to your file. Patient/practitioner confidentiality may be a vanishing concept, but in some ways I am just old-fashioned. I believe that what you tell me about your physical/emotional/life circumstances is, ideally, nobody else's business unless you wish it to be. In addition, my place of practice could be entered and inspected (including patient files) at any time.
4. I would be required to carry a $1,000,000 malpractice policy. I suspect that someday, this will be required of all licensed acupuncturists, but I will be a holdout until that day comes. Acupuncture done by experienced practitioners is an extremely safe procedure. Almost all complaints nationwide involve questions of inappropriate behavior, rather than cases of physical injury. In addition, this imposes a significant financial burden to part-time practitioners. But more importantly, my practice involves and requires relationships of trust. I develop a unique and confidential partnership with each of my patients. It feels inappropriate to me to hold up a huge, money-based wall of defense to protect myself from people in need who are putting their complete trust in me. Trust is a mutual relationship. Again, I confess, I'm the anachronistic idealist. For a vastly more articulate expression of the evils of malpractice, refer to Gesundheit by Patch Adams, MD.
5. I object to the entire concept of "preferred provider". The Washington State Board of Health does an excellent job in maintaining high standards for all licensed acupuncturists in this state. Calling their approved "providers" (I hate that term too) "preferred" is misleading. The insurers prefer these practitioners because they agree to the above conditions.
6. Yes, there are hours and hours of required paperwork. In addition, it is remarkable how much time my fellow practitioners spend on the phone, pleading with insurers to pay up on their bills. Besides this time requirement, it is disheartening to regularly receive messages of disrespect, and subtle reminders that I am no longer my own boss.
7. I believe that the entire concept of health insurance for (immense) profit is unethical.

Here is an actual quote from American Acupuncture Council, 7/7/08, sent with their upcoming seminars announcement to entice acupuncturists to take their seminar:

"Quick Tip of The Week

Billing timed services: When billing physical medicine timed services the chart notes must indicate the time the service was performed. Time is what the carrier is paying for and will review for time should the file be audited. Note 8 minutes is the minimum time for any 15 minute service but multiple services on the same visit are cumulative. Therefore to get paid 1 unit of two different services you must spend a cumulative time of at least 23 minutes (1 unit = 15 minutes and 2 units must be 15+8 or a minimum of 23 minutes spent cumulatively). If only 8 minutes were spent on each service the total time is only 16 minutes and qualifies for only 1 unit. However the more expensive to the two may be billed."

~ any questions?

Here's mine: Is this what you want your practitioner thinking about while deciding your treatment? Someday this country will have sane, single-payer health care for all. Until then, I am committed to providing quality AND affordable care. Your health is priceless. Please don't delay taking steps to maintain it.

Lesli Dalaba, L.Ac.
Seattle, WA
WA State License No.150