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Acupuncture health care and California health plans

It was not that long ago that people would ask if acupuncture was covered and there was a resounding "no".  An ongoing trend is that acupuncture coverage is becoming more commonplace with California health insurance plans.  In general, health plans have slowly moved towards covering more preventative health care and alternative health care costs.  Acupuncture is usually grouped under the "alternative health care" banner with chiropractic but it has become more mainstream both in terms of use and as a matured and licensed means of medical care. 

When you run a California health insurance quote, you will see acupuncture care broken out from office visit copays and usually, it is listed separately by itself.  You may have to click on the plan name to access the brochure for more detail on how the plan treats accupuncture.

Since the underlying issues that require acupuncture care are typically more chronic in nature (last long periods of time if not indefinitely), there may be caps on the number of covered benefits in a given year.  The cap can be more than for chiropractic but there may not be the ability to get authorized for more visits.  

Here are key concerns when looking for a health plan that best handles acupuncture:

1.  Number of office visits.  Many plans cap the number of office visit copays per calendar year to a few visits.  First, see if the acupuncture visit is part of the normal office copay visits and secondly, double-check how many you may receive.

2.  Many practioners do not participate in health carrier networks which means much more out of pocket (for PPO) or no benefit when seeing these providers.  Double check the California doctor lookup and try to stay in network for the best benefits. 


On the Small Group market, some health plans offer Acupuncture riders which add additional or better acupuncture benefits.  A "rider" is a like a side insurance plan added to the main medical plan.  The "rider" can cover acupuncture, chiropractic, cancer, infertility, or a specific medical benefit that traditionally is not covered or has limited benefits compared to the core medical plan coverage.


Chiropractic care better explained

For further reference, an explanation of Chiropractic as described by Health360 through Anthem Blue Cross

Medical review: 2003

Contributing Author: Cherri Straus, MPH

Acupuncture, which originated in China 2500 years ago, is one of the oldest, most commonly practiced medical procedures in the world. Acupuncture became widely known in the U.S. in the 1970s and by 1995, there were over 10,000 nationally certified acupuncturists practicing in this country with the number expected to double in the year 2000. The Food and Drug Administration approved acupuncture needles for use by licensed practitioners in 1997. Currently, one-third of acupuncturists are medical physicians. Non-physician acupuncturists practice more traditional oriental medicine and must meet licensing and certification requirements. The National Institutes of Health has termed acupuncture “an acceptable alternative, or part of a comprehensive treatment program” for certain medical conditions.

Acupuncture involves stimulation at specific points on the body by puncturing the skin with sterilized, flexible, very fine needles. These points on the body are believed to stimulate the central nervous system to release chemicals into the muscles, spinal cord, and brain. These chemicals can help reduce pain and inflammation, and may also trigger the release of other chemicals to stimulate the body’s natural healing abilities and promote physical and emotional well-being. The Chinese call this restoring one’s “qi” (pronounced chee) which is translated as one’s “energy flow”. Variations of traditional acupuncture include Moxibustion – the process of burning dried herbs on top of the needles for treating certain health conditions, and Electro-acupuncture – when the needle points are stimulated electronically.

Acupuncture practitioners will usually discuss your complete medical, personal, and family history with you in great detail in order to obtain a complete picture of your treatment needs and personal behaviors that may contribute to your condition. It is important that you tell the practitioner if you are pregnant, have breast or other implants, have a pacemaker, and what medications and other treatments you are currently taking. In some cases there may be bruising or irritation after the treatment, but the procedure itself produces minimal pain since the needles are hair-thin and hollow.

Lifestyle, age, and physical factors combine to make every person different and you should not rely on stories and hearsay about acupuncture to influence your decisions about healthcare. A treatment that works for one person may not work for another person, even with the same condition. Ask your physician or call the American Academy of Medical Acupuncture (800)-521-2262 for referrals to licensed acupuncturists Check with your benefits administrator regarding coverage for acupuncture under your health plan.

This information is provided for educational purposes only and is not a substitute for sound medical judgment. If you have any questions or concerns, you should discuss them with your physician.




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