Maximize BCBS Acupuncture Benefits Before Year-End

Categories: Insurance Coverage

Blue Cross Blue Shield (BCBS) Acupuncture Benefit

At the beginning of the year, we were excited to hear of many new corporate BCBS plans that included acupuncture as a benefit for its members. Since we are in network with BCBS, we were excited to finally give patients what they were asking for.

As is the case with most insurances for acupuncture we have found this has come with several “catches” to policies, but the main takeaway is if you have BCBS and met your deductible for the year, get your acupuncture before it resets in January! Let’s go over everything below:

1. We currently only take BCBS for acupuncture. If you have BCBS and want to know if you have the benefit, call the number on the back of your card. If you are a current patient and would like us to check for you, Avalon will photocopy your insurance card at the front desk so we can look it up. All other insurers we can provide a superbill for reimbursement but there is no guarantee of reimbursement depending on the companies out-of-network policies.
2. Deductibles – many of the plans we have come across this year unfortunately require that you meet your deductible before they begin paying for your treatments. This means if you have a high deductible that has not been met, it’s probably best to get the cash discount price rather than pay full price trying to meet your deductible.
   If you have a few hundred dollars left the first few acupuncture visits will apply to the remaining deductible and future visits will be paid for by BCBS. When you call to check if you have acupuncture benefits, also ask if you must meet your deductible first and how much remains.
   We can look up remaining deductibles on Blue Cross’s portal; however, the system is very inconsistent in relaying if a deductible must be met first. (we frankly think deductibles are outrageous if you are paying monthly for insurance, but here we are)
3. If you have acupuncture coverage and you’ve met your deductible – use your benefit! You pay for this insurance plan one way or another, make them pay for your care! It will reset January 1st, so get all the appointments you want before the end of the year!
4. Copays – we have found some plans have them, others do not. They range from $20-40 depending on your plan. Again, you can call and ask or we can look that up for you.
5. Medicare supplemental problem – in 2018 Center for Medicare Services approved acupuncture for low back pain to all those who have Medicare. The problem is acupuncturists are not listed as providers under Medicare, and it takes an act of congress to add our licensure. Until that happens, we are unable to bill Medicare.
   This creates a problem for us with billing because BCBS wants a denial letter from Medicare before they will pay for a claim. Since we are not providers, we are unable to access Medicare’s system and get the denial letter they want. Therefore, they will not pay no matter how many times we call and explain to their call center the situation and try to find a solution.
6. Medicare supplemental superbill – our only solution we have found that works in most cases is paying at time of service and we will generate a superbill for you. You can then submit this to your insurance for reimbursement. Reimbursement amounts vary by plan and company from 40%-95% of the total visit cost. We cannot guarantee their reimbursement and there is no reliable way to look up what reimbursement they will give until you submit the superbill.
7. Other insurances – at the time being we are not planning to join Aetna, United, or other insurance providers. Either their reimbursement rates are insultingly low or they are notorious for denying claims for those with acupuncture benefits which wastes everyone’s time and money. We’re here to provide healthcare not chase tens of dollars from unscrupulous companies, so for the foreseeable future BCBS will be the only company we will remain in network with.

We know this is a lot of information and a lot of it is confusing. If you have any questions, feel free to call or e-mail us, and we will do our best to clarify. The main takeaway is still, if you or someone you know has BCBS and met their deductible for the year, get your acupuncture!