Lesli Dalaba, Seattle Acupuncture : Insurance Information

Lesli Dalaba: Acupuncture in Seattle on Capitol Hill

The Complete Skinny on Insurance

Will your insurance plan cover my fees?

If you have been injured in a auto or motor vehicle accident, it is almost certain that your (or the other party's) car insurance will pay me in full for as many visits as are reasonably necessary. This is a completely separate system from your health care plan, and I am happy to bill the insurance company directly.

For all other conditions, I recommend that you call your insurance provider and ask them the following two questions:

"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.)
"What percentage will you pay for out-of-network practitioners?"

Make sure that you also understand the amount of your deductible, and for which conditions your plan covers acupuncture (often, only pain conditions). Although I am not listed on your provider list (see below), 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.

Lesli's Rant on HMOs & PPOs
or
Why I am not a "preferred provider" on your insurer's list

My usual response is "Don't get me started!", but I realize that my insured patients deserve a rational, calm explanation of why my personal ethics keep me on the outside of their major health care provider system. (I am referring here to Blue Cross, Regents, Group Health, etc.) I have listed my major reasons below. It is also very important to me that my position does not prevent anyone from seeing me who wishes to. (Please read the paragraphs above, under "Will your insurance cover my fees?" for details on how we can still work together.) I am committed to providing affordable care to the full extent that I am able.

All right, enough procrastination; let's get started.

If I were to sign a contract to join a provider list:

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.
I would be prohibited from doing direct moxa – a technique of major importance in my practice, and an extremely effective home self-care technique.
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.
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 trust in me. After all, I am hoping that my patients will feel comfortable enough to let down their defenses in my presence. 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.
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.
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.
I believe that the entire concept of health insurance for (immense) profit is unethical.

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