How to Understand Insurance Coverage for Acupuncture and Chiropractic

Chiropractor and Acupuncturist Chapel Hill, NC

Increasingly, many insurance plans cover chiropractic and acupuncture care. At Acupractic Natural Healing Center, the Triangles’ source for both acupuncture and chiropractic, we get many questions about insurance coverage for these treatments, and we are happy to assist people as they look for answers. We strongly believe that patients benefit from clarity in pricing and in knowing what to expect with regards to our billing procedures and prices. For this reason, we are posting this information. Additionally, front desk personnel are available to discuss each patient’s unique needs and concerns before new patient visits and when insurance changes; if necessary, ask to schedule a phone consultation for more detailed information. 

We ask patients to provide us with their personal information, including their name, address, date of birth, phone numbers, insurance carrier name, insurance number, and any group numbers. If available, we obtain a copy of the patient’s driver’s license and insurance card. Patients can let us know what type of care they want- chiropractic, acupuncture, or both, and whether treatment is wanted for a particular problem, or if they want consideration for maintenance or supportive care.

Our front desk personnel will contact the insurance plan to verify benefits and inform each patient what to expect. Some insurance plans require patients to pay a copay (a set amount per visit), and/or coinsurance (generally a percentage of allowed amounts, usually 20%). Most insurance plans do not cover the required initial exam; if patients want to receive treatment on the same day of their initial (or re-exam), they must pay. Also, most insurance plans will not cover the chiropractic exam and the acupuncture services exam; for patients requesting both chiropractic and acupuncture treatments together, this entails a small additional fee.

Dr. Lisa Oskardmay is a licensed Medicare provider, and Medicare pays for the chiropractic adjustment at our office. Medicare does not pay for the required initial exam or re-exams; patients pay for these. Additionally, Medicare does not pay for other therapies in our office that help patients get well and improve, including massage, lifestyle counseling, nutrition advice, exercise prescription, physical therapy modalities such as TENS unit, ice or heat, trigger point therapy, cupping massage. We collect an additional general office visit fee to cover these therapies.

Importantly, nationally, Medicare does not cover acupuncture care, despite saying they do and despite listing us as providers. This confusing fact is because the US does not recognize Licensed Acupuncturists (LAc) as Medicare providers yet. As legislation changes, we will be sure to update everyone!

Insurance plans are constantly changing, and we will always keep patients aware of new changes within their insurance plans when we can. For instance, the new requirement under BCBS plans is that providers obtain therapy authorization before coverage. Please be advised that unauthorized, nonbillable therapies are then the patient’s responsibility. Also, some insurance plans have different copay/coinsurance rates for various aspects of the visit- chiropractic, acupuncture, PT modalities, exams, and re-exams. Additionally, acupuncture coverage for some diagnosis codes may be limited. It is always the patient’s responsibility to know their insurance.

We are grateful for the thousands of NC patients who have chosen us over the last 30 years to provide their integrative and alternative medicine needs with chiropractic and acupuncture services. Call today to schedule your appointment at 919-929-1400, or visit us online 24 hours a day to schedule online and learn more about how natural healthcare can help you feel better faster.