Why I have very mixed feelings about being a “preferred” provider for insurance companies, and why we need sane, single-payer health care coverage in this country.
For now, I will continue to be a provider for the companies listed on my website, because I know that for some people it’s the only way they can continue to get treatments from me. I am committed to providing high-quality and affordable health care and will continue to be part of the health insurance maze . . . until I find I can’t do it anymore. But we all might want to consider the downside of using insurance to pay for acupuncture. Here are just a few thoughts (with thanks and much credit to Seattle acupuncturist Lesli Dalaba, from whose rant on this topic I cribbed a great deal because it resonated so strongly.
1. Insurance companies dictate based on dollars, not necessarily good health care
Insurance companies impose limits on what conditions acupuncturists are 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 could lead some practitioners to be not entirely truthful on their patient records in order to be reimbursed, leaving all non-pain complaints out of the notes. This is a sticky situation, with all options a bit distasteful.
Acupuncture is an effective and affordable approach for many conditions besides acute or chronic pain, including depression, asthma, gastrointestinal disorders, women’s health issues, auto-immune conditions, sinusitis, colds & flu, insomnia, breech position of fetus, late delivery, side effects of chemotherapy, and dozens of other conditions acknowledged by the World Health Organization. Many people use it simply as a health maintenance regimen, to stay healthy! As a “preferred” provider, I am told to focus only on pain conditions. This goes against everything I was taught in acupuncture school, which was to look at the whole picture, to ask questions about every facet of a person’s health and lifestyle and thereby put together the pieces of a puzzle that determine that individual’s “pattern,” or diagnosis.
2. Confidentiality is compromised
Anything that is billed to your insurance goes into your permanent medical records. Many people at the insurance company have access to your file, plus as a “preferred” provider, I am placed in a position of potentially being audited—my office could be entered and inspected (including patient files) at any time.
When a patient pays me directly, no one outside of the two of us ever needs to know a thing about it, including what you are seeing me for. We can talk privately about anything and everything on your mind. In Chinese medicine we see no separation between mind and body, between emotional, mental, and physical complaints, and by considering all aspects of your situation, I’m much better able to find the best treatment for you, without an insurance company peering in through a peephole.
3. Insurance companies are increasingly denying coverage and/or changing the rules
Acupuncturists are required to break down billing for sessions into 15-minute segments, each segment having its own separate code. In addition, every action I take during a session requires a separate code—if I use cupping, that’s one code (and gets charged a certain amount), moxa is another code and charge, the heat lamp is another code and charge . . . same with electro-acupuncture or hands-on work. Insurance companies have recently and arbitrarily begun denying some segments, or some specific actions used—for example, cupping or moxa or a second segment (“unit”) of 15 minutes spent doing acupuncture (30 minutes total)—and so this then becomes the financial responsibility of the patient. My billing person and I have to read the fine print on the claim forms and decipher how much the patient owes on the balance and then send the patient a bill . . . and keeping track of all these ridiculous little segments is a paperwork nightmare, which brings me to . . .
4. The paperwork involved is a nightmare!
This may not seem like a downside for you, the consumer—only for me, the practitioner—but it does indeed have a trickle-down effect. The extra hours plus the cost to pay an outside billing person may force me to eventually have to raise my fees in order to break even, especially now that insurance companies are balking at paying a reasonable amount for acupuncture services (see #3). Aside from the extra hours and cost (and frustration), it is disheartening to regularly receive claim returns that show disrespect for this ancient, effective medicine . . . and reminders that I am not my own boss, at least in regard to insurance companies.
5. The concept of “preferred” provider is objectionable
We acupuncturists are licensed by the Washington State Board of Health, which does an excellent job of maintaining very high standards in this state. The title of “preferred” provider is misleading—the companies “prefer” me (and other “preferred” providers) because we’ve jumped through their hoops and have agreed, however reluctantly, to the requirements they stipulate—that is: pain conditions, certain (reduced) fees, oversight by people who know nothing about Chinese medicine, loss of confidentiality, and the potential for inspection/audit.
6. The entire concept of health insurance for (immense) profit is unethical.
It’s pretty crazy and sad that the U.S. is the only industrialized country without universal health care, primarily because of the insurance lobbyists and others with a vested interest in keeping the very dysfunctional status quo. We need universal health care and the public option proposed by President Obama. I encourage all to write your congress people, senators, and the White House to support the changes being proposed. Things won’t get better unless we make ourselves heard!
I wish you health,
Nancy Moore