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Insurance Information & Verification

We will need to check with your insurance provider to verify if acupuncture and/or myofascial release/trigger point (manual therapy) services are covered.  We will also check the number of allowed visits, deductibles, and co-pays/co-insurance so you will know exactly what your share of charges are before your first visit.

SINCE INSURANCE INFORMATION CHANGES CONSTANTLY, WE WILL STILL NEED TO VERIFY THE INFORMATION BELOW!!

There are other companies that cover acupuncture and manual therapies (myofascial release) other than the ones listed below, and we will need to check by calling them.  You are responsible for all co-payments and un-met deductibles at the time of service.  Ultimately if we are billing for you and an insurance company refuses payment, you will be responsible for charges, even when we have verified coverage in advance.  If they refuse payment, we will work with you on a financial arrangement.

Sometimes insurance companies that don't normally cover services, will pay if you can prove you are saving them money, i.e. reducing medications or avoiding surgery.*  We have a letter available on request that we can send to the insurance company on your behalf, encouraging them to cover acupuncture services. 

*(i.e. the State of Alaska will consider acupuncture on a case-by-case basis, if you can prove you are saving the State money.  This does not include GGU and other bargaining units who are now covered under plans provided by your unions/health trusts i.e. ASEA.)

Medical Necessity: This does not mean that you need a doctor’s referral or supervision. It just means you have to be treated for a legitimate medical condition, and they will not cover the excluded items listed in your booklet, such as "stress", and for cosmetic reasons. When we verify your eligibility for benefits, we have to tell them what we are treating you for, and they tell us if they will cover it.

AETNA  Alaskan Natural Care is a preferred provider, but not all plans cover our services, and benefits vary from plan to plan.  We will need to call to check your benefits.
ACS (Alaska Communications Systems)   Acupuncture is covered at 80%.  No limit on number of visits per calendar year, but Aetna may request documentation of medical necessity after the 25th visit.
Anthem  Some Anthem insurance companies will honor Alaska Blue Cross preferred providers for the preferred provider rate.  We will need to check with your insurance company.
Auto Accidents (Personal injury cases)
are usually covered, but we will need to check for sure and find out your benefit limits, if any, and see if you need a written referral from a doctor.  We will only accept cases where we bill the insurance company for you, unless you have already settled your case.
Alaska Electrical Health and Welfare Fund (IBEW)
covers acupuncture for pain only. 2016:  Covered at 85% until the out-of-pocket amount of $2700 is reached, then at 90%.  Once out-of-pocket of $5400 is reached, then at 100%.  No limit on the number of visits.  No medical massage/manual therapy benefits, unless supervised by a chiropractor.
Alaska Laborers Construction Industry Health & Security Fund covers acupuncture.
Alaska Native Tribal Health Consortium covers acupuncture at 80% with 12 visits per year, and massage with no limit to the number of visits, both at 80%.  $200 deductible, until $1200 is paid out-of-pocket, then at 100%.
Anchorage Municipality covers acupuncture at 80%, with a $250 deductible until $2000 is paid out-of-pocket, then at 100%.  No limit on number of visits or other restrictions, but a Letter of Medical Necessity is required after 20 visits.
ASEA Health Trust (State of Alaska GGU bargaining unit) starting July 1, 2011, covers 20 visits per fiscal year (July 1) total for acupuncture, massage therapy, and/or chiropractic appointments.  20% co-pay.

Blue Cross   (Alaskan Natural Care is a Blue Cross of Washington and Alaska Preferred Provider)
All local Blue Cross plans are now covering acupuncture, including the new Health Exchange plans. (some State plans do not, i.e. New York).  If acupuncture is covered, medical massage/manual massage is covered through this office. 
Some Blue Cross plans cover medical massage/manual therapy through an acupuncturist, even if acupuncture itself is not covered.  Some employers/groups include:

       Alaska Airlines (20 visits/year, 20% coinsurance)
       Alaska Bar Association
(12 visits/year, $20 co-pay and then 100% of the maximum allowed)

       Alaska Public Employees Association (Details unknown)
       Beacon O.H.S.S (12 visits/year, $25 flat co-pay)
       Catholic Community Services
has Blue Cross of California. They cover acupuncture for pain
management only. (12 visits/year, maximum $25/visit, with a $15 co-pay, so they only cover $10/visit)
      Crowley Marine Services - covers acupuncture at 80%, 12 visits/year, with the deductible specially waived for this service.
      FEP:  Standard Option - (2016) is subject to a $350 deductible, then a 15% co-pay for acupuncture, or a flat $25 co-pay for manual/massage therapy.  Acupuncture 24 visits/year, manual/massage therapy 75 visits/year.  Basic option (2016) - 10 acupuncture visits/year, 50 massage therapy/manual therapy visits/year.  Acupuncture and manual therapy/massage therapy are not subject a deductible, and have a flat $30 co-pay.
      Holland America - has Blue Cross of Washington.  (12 visits/year, covered at 80%, $300 individual deductible)
      Inland Boatman's Union - covers acupuncture at 80%, 12 visits/year, with the deductible specially waived for this service.

     
South Central Peninsula Behavioral Health allows 12 acupuncture visits and 45 Massage/Manual Therapy appointments.  Because we are in-network, your co-pay is 20%.
      University of Alaska
 - allows unlimited number of visits for acupuncture, covered at 80% until you have met your out-of-pocket maximum, then at 100%.
 

CIGNA - It depends on the plan. I no longer bill CIGNA due to difficulties reaching their provider service agents, but I will provide you with a bill you can submit for reimbursement from your insurance company.
Federal Express (Fed Ex)
insurance has covered acupuncture in the past.  (20% co-pay, $150 deductible, no restrictions other than conditions not allowed by your plan.)  Current coverage unknown.
FEDERAL PLANS
The Federal Plans that we are aware of at this time that cover acupuncture are Mail Handlers (see http://www.mhbp.com), Letter Carriers, and FEP (see above). All Federal employees have the option to elect these plans.  FEP does cover manual therapy/trigger point therapy/myofascial release/massage therapy through this office (even though the plan says massage therapy is not covered, they mean they do not cover massage therapists.  Myofascial release/manual therapy/trigger point therapy is what is performed, which in insurance terms is not the same as massage therapy.)
GEHA  -   I no longer bill GEHA due to difficulties reaching their provider service agents and difficulties getting payments from the company as a provider, but I will provide you with a bill you can submit for reimbursement from your insurance company.
Golden Rule
Golden Rule covers acupuncture.
HEALTHCOMP

Usibelli Coal Mine (Healy) - 24 acupuncture visits/year (any Naturopathic visits also count toward the 24 maximum visits).  Subject to $300 deductible.  Coinsurance of 10%, amount unknown at this time until the first claim is processed since Healthcomp could not tell me the allowed charges.  Non-network provider.  Massage and manual therapy are covered.
MEDICARE, Medicaid, and Denali Kid Care do not cover acupuncture or medical massage.
MERITAIN (previously RBMS) has 50 different plans, so coverage varies by plan.  Our office will need to call the insurance company for specifics.
   Known Covered Plans:
   Alaska USA Credit Union has a $100 deductible, pays 80% of charges, has no maximum number of visits per year, and requires medical necessity & verification of claim.
   Kenai School District covers acupuncture and manual therapy (performed by an acupuncturist) at 80%.  Unlimited number of visits, as long as medically necessary.   
   SouthCentral Foundation covers unlimited acupuncture visits, and 30 massage visits with no referrals.  Manual therapy requires pre-authorization since the plan is "silent" on that benefit.
   YKHC covers insurance that is "medically necessary."  I will get a list of conditions you want treated and submit a request for predetermination of benefits for you.  This takes at least 10 business days from the day I submit it. Benefits are covered at 80% after you have met your deductible.
NEA ALASKA (Teachers, except for Kenai Borough teachers)
are covered at 80% for both acupuncture and myofascial release, with a $100 deductible.  You do not need a referral from a doctor.  Unlimited number of visits per year. Starting 7/1/11, for most conditions, we will need to submit a request for pre-authorization to see if your treatments will be covered.  Acupuncturists are under the EBMS definition of "physician."   Please call our office for more information.
State of Alaska Retired (Wells Fargo) does not cover acupuncture, but it will cover massage/myofascial release/manual therapy with a referral from a health care provider.  Call for details.

State of Alaska Correctional Workers
- covers acupuncture, no limit # of visits, 20% coinsurance (processed through Aetna) $350 deductible.

State of Alaska Laborers Union Local 71 Health Trust - $300 deductible, 20% coinsurance, 16 visits per benefit year (July 1 - June 30) acupuncture combined with chiropractic visits (16 total visits between acupuncture & chiropractic care).  Aetna administers the plan for the Health Trust.

ASEA Health Trust - see information near top of page.
Teamsters (Alaska local) - 10 acupuncture visits/calendar year.  20% coinsurance, subject to $400 deductible.  Massage/manual therapy is covered when performed by a PT.
UMR - I no longer bill UMR due to difficulties reaching their provider service agents and difficulties getting payments from the company as a provider, but I will provide you with a bill you can submit for reimbursement from your insurance company.
     Alaska Housing Finance - does cover acupuncture.  Pays at 90% after $100 deductible met, then 100% after $200 out-of-pocket met.  No limits on the number of appointments or benefit maximum.
    MEA Electric - does cover acupuncture at 70%.  No limit on number of visits, but does require documentation of medical necessity after the 25th visit.
    National Rural Electric Cooperative - is covered 70% after the deductible is met. Documentation of medical necessity is required after 25 visits.  Maximum 25 visits combined acupuncture, physical therapy, and occupational therapy.
United Healthcare has several plans, so coverage varies by plan. I no longer bill United Health Care due to difficulties reaching their provider service agents, but I will provide you with a bill you can submit for reimbursement from your insurance company.

    Wells Fargo Bank employees get 26 acupuncture visits/year, and 20 manual therapy visits, covered at 80% once your deductible is met.
VA (Veteran's Affairs) does cover acupuncture with a VA doctor's referral, maximum 24 visits/calendar year, but Alaskan Natural Care  does not accept TriWest/Open Choice.  Funding is no longer available directly through the VA, so we no longer accept VA patients.  Check with the VA for a list of providers that do accept TriWest/Choice program.
WORKER'S COMPENSATION
covers acupuncture and manual therapy/myofascial release, and you will need to bring a doctor's written referral to the office on the first visit.  We will need to confirm coverage with the company prior to your appointment, so be sure to tell us this is a Worker's Comp case.  You will want to check to make sure your case was opened.  We are required to bill Worker's Compensation for you.  Federal Worker's Compensation is not accepted due to issues with payments.
YK School District does not cover acupuncture. If you have this insurance, let your administrators know that you would like this covered in future plan revisions.

HEALTH CARE REIMBURSEMENT ACCOUNTS and MSA's:
These accounts allow you to set aside pre-tax dollars and use it to pay for expenses your regular plan does not cover, such as deductibles, your co-pay amount, and non-covered expenses such as acupuncture (allowed items are listed in IRS publication 502, "Medical and Dental Expenses").  Medical massage is not covered.  The advantage is that you do not pay taxes on this money (FICA, Medicare, and Federal Withholding).  There is a maximum you can contribute per year.   The State provides their employees with this option, and if you are self-employed you can set up an MSA through some insurance companies.  For the State of Alaska employees, you need to elect this option and state the amount you will contribute during your open enrollment period (in May), then that amount is deducted from your paychecks.  (You have to elect a HCRA annually if you want to be covered for the subsequent benefit year!)  You need to use-it-or-lose-it during the benefit year, but you can spend it before you have contributed all of it (i.e., you can spend $500 in the first month, even if you have only contributed $50 at that point).   The State does not charge an administrative fee to administer your HCRA account.  For more information, contact your Retirement and Benefits section.

For self-employed MSA's, the rules are different, in that you can accumulate the unspent money and take it out after age 65 (like an annuity).   You contribute monthly amounts, but you may contribute additional amounts during the year up to a maximum amount in lump sum contributions.

Palmer, Alaska Acupuncture Clinic
Wasilla, Alaska Acupuncture Clinic
Mat-Su Valley Acupuncture Clinic
Alaskan Natural Care, Inc.     info@triggerpointrelief.com     (907) 435-7060
The information contained in this trigger point book on CD-ROM is for informational and educational purposes only. It is not intended to diagnose, cure, or prevent your specific medical conditions or prescribe medications or supplements. As with any health condition, you need to see a licensed practitioner in the appropriate specialty for diagnosis and treatment. Accessibility statement.
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Copyright © 2004-2018 Valerie DeLaune, LAc