Beginning last year, Medicare started covering acupuncture treatment for seniors suffering from chronic low back pain. Medicare acupuncture back pain coverage is a good thing, and we have treated many patients with this new benefit. Unfortunately, Medicare is not covering all patients equally, and they need to fix the reimbursement system. Today’s blog post describes what we’ve learned about the new benefit and suggestions for Medicare so the benefit can reach more people in need.
The Good News
The good news is that if you have United Healthcare Medicare Advantage or Aetna Medicare Supplemental insurance, you can receive up to 20 acupuncture treatments for chronic low back pain and just pay your copay. Raleigh Acupuncture is in-network with both United Healthcare and Aetna, enabling us to file claims to those companies on our patients’ behalf.
The Bad News
The bad news is that while Medicare acupuncture back pain coverage is technically available to all seniors, they did not authorize acupuncturists to file claims directly to Medicare. Without this ability, acupuncturists must file claims through a third party. At Raleigh Acupuncture, we have successfully filed claims with United Healthcare and Aetna because we are in-network with them. However, when we tried to file claims through Humana on behalf of Medicare patients with Humana supplemental plans, they denied the claims. They told us to file directly with Medicare – which Medicare currently does not allow.
More Bad News
Blue Cross Blue Sheild and Cigna now offer Medicare acupuncture back pain coverage. But there’s a catch. They only pay acupuncturists 25% of the reimbursement rate, keeping the rest for themselves. They make patients pay a majority of that rate in the form of their copay, while they pay the acupuncturist just $10 more, pocketing the balance for themselves. In other words, Medicare issues the standard payment to Cigna and BCBS, and the insurance companies take 75% for themselves, making the patient pay 20% and paying the acupuncturist 5%.
Not only is this unjust, but it should also be illegal. Furthermore, no acupuncturist can afford to provide acupuncture for chronic low back pain for 25% of the Medicare rate. We can’t run our clinic for that fee. It’s like asking a movie theater or Five Guys to charge $2 for a movie or a burger or expecting gas stations to only charge 50 cents a gallon for gas.
The Better Solution
The simple solution to this Medicare acupuncture back pain coverage problem is to allow acupuncturists to file claims directly with Medicare. That way, third-party insurance companies would not be involved, taking away their power to make profits on the backs of seniors. Research has overwhelmingly confirmed that acupuncture reduces chronic low back pain. Medicare owes it to seniors to follow through on this new benefit by allowing acupuncturists to file claims for these patients.
Next Steps
If you have Medicare, call or write to your members of Congress and ask them to fix this problem.
If you have United Healthcare Medicare Advantage or Aetna Medicare Supplemental insurance, you’re covered. Feel free to book an appointment online.
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Medicare Acupuncture Back Pain Coverage
This benefit is less than a year old. While promising, it has some significant flaws. Let’s work together to fix the problems so seniors can get the benefit they deserve.
