National
Acupuncture and Oriental Medicine Alliance National
Acupuncture and Oriental Medicine Alliance
IF AN INSURER REFUSES TO COVER ACUPUNCTURE OR ORIENTAL MEDICAL TREATMENT
Steps To Take - reprinted from the Acupuncture Alliance quarterly newsletter, The Forum
If an insurer refuses to cover acupuncture or Oriental medicine treatment:
1) Make sure you are asking the right question. Even within the same company, policies may differ. A policy may pay if treatment is recommended by an MD, performed by an MD, performed by a licensed acupuncturist, performed by an approved provider, when medically necessary, only for the treatment for pain, etc. You or your patient should provide the correct policy number and ask if acupuncture/Oriental medicine is covered under this policy. If it is covered, ask under what circumstances it is covered and whether there are any limitations or stipulations such as the number of treatments and/or conditions covered, who must perform the treatment, etc. Take notes and get the name of the person providing the information. Ask that a copy of the provisions regarding acupuncture/Oriental medicine be sent to you and/or the patient in writing.
2) Make sure the information is correct. Frequently employees are misinformed. If the employee is vague, insist that someone more knowledgeable be consulted.
3) You or your patient, or both, may write a letter to the insurer. If so, send the claim with a cover letter that includes:
* A statement that you are licensed by the
state. Attach a copy of your license and the law.
* A statement that licensed acupuncturists provide services similar
to those of other licensed medical professionals.
* Your patient may wish to provide a personal statement of the
time, effort and expense consulting other practitioners prior
to acupuncture/Oriental medicine and the success with acupuncture/Oriental
medicine treatments by a licensed provider.
Consider including other material such as the information at the right or pertinent research from Acupuncture Efficacy.
You may wish to include a statement that other companies pay for acupuncture/Oriental medicine and that this company should also if it wishes to remain competitive. Send a copy to the marketing director of the company.
4) You may wish to file a complaint with the state insurance commission. In many states the insurance commissioner is an elected official who must stay in touch with public demands.
5) Consider sending a copy to your legislator and ask if he/she would be interested in sponsoring a parity bill so that consumers in your state can enjoy the benefits available in other states.
Provide The Facts
* Thirty-eight states and the District of Columbia have passed statutes or regulations for the practice of acupuncture and Oriental medicine. Legislation has been introduced in an additional eight states.
* The Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) is recognized by the US Department of Education. Acupuncture is a three-year masters level program. Oriental medicine is a four-year masters level program. Over forty colleges are accredited or in candidacy status.
* The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) offers four independent certification programs: Acupuncture, Chinese Herbology, Acupuncture & Chinese Herbology, and Oriental Bodywork Therapy. The NCCAOM has certified over 9,000 practitioners.
* Acupuncture is used in more than 20 states in over 800 drug dependency programs. Patients who go through these programs have lower rearrest rates on drug-related charges than those not treated with acupuncture. In Miami-Dade County drug offenders have a choice of acupuncture or jail.
* The 1997 National Institutes of Health Consensus Conference on Acupuncture recognized the effectiveness of acupuncture in the treatment of several diseases and stated that "One of the advantages of acupuncture is that the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same conditions."
* The FDA has classified acupuncture needles as medical devices for general use by trained professionals.
* A study in six clinics in five states showed efficacy and cost savings of acupuncture. Of the patients treated with acupuncture, 91.5% reported disappearance or improvement of symptoms; 84% said they see their MDs less; 79% said they use fewer prescription drugs and 70% of those to whom surgery had been recommended said they avoided it.
* The FDA estimated in May 1993 that there were 9 to 12 million patient visits each year for acupuncture.
* Controlled clinical trials in the United States have evaluated the use of acupuncture combined with standard stroke protocol for the treatment of paralysis due to stroke. Effective or markedly effective results were found for over 80 percent of the patients receiving acupuncture with a cost savings of $26,000 per patient.
For additional facts, see Quick Facts under General Information