I keep hearing questions and complaints about insurance billing and acupuncture. I don’t have an original post ready. This is adapted from an email exchange with some colleagues and thought it might be a good starting point for a conversation, despite the odd lack of context. But if you’ve been around for a while you can probably imagine what preceded it! (Then again, we should probably be out enjoying a holiday weekend rather than pondering our profession’s future.) —
“I am absolutely fine with practitioners pursuing all of the various business models that are available to us. I want anyone who wants acupuncture to find a way to access it. Depending on both the practitioner and the patient, there may be certain models that are more appropriate or appealing than others. Private room treatments at varying levels of cost with the money coming directly from the patient or indirectly via an insurance company, sliding scale models, in group or private settings, treatments as part of other medical care, I’m good with all of it. I don’t believe that a patient’s willingness to make life changes is related to what they are paying for treatment. I don’t believe that lots of talk and time is necessary for people to benefit from treatment, though I believe it can have benefits.
“I do believe that lots of graduates come out of acupuncture programs with very little information about how to choose which model might be best for them or for the community in which they wish to work. I believe they often come out having been told some version of “if you build it they will come.” It makes me sad and angry when folks who invested so much in their education don’t have the business skills to make a go of it, especially when there are so many areas so underserved by LAcs.
“I don’t believe that fraud is necessary to make a living from an insurance based practice, and, I have seen many conversations about insurance billing for acupuncture that revolve around questionable practices. I certainly don’t think all practitioners engage in these practices, but some do. I also see practices that are by the book, but are still likely to have unconsidered consequences. How many acupuncture treatments that are not billed to insurance involve three distinct sets of needle insertions, compared to those that are billed. Does it take more sessions to treat back pain with acupuncture when the treatments are covered by insurance? (Does the billing provider think of the treatments as being preventative once the back pain is in remission while the non-billing provider might not be thinking about back pain at all and instead pondering the client’s inability to relax even when on vacation?) How do the answers to these questions impact data on the cost effectiveness of acupuncture? As purchasers of health insurance, how do we feel if we think an MD is doing a more complicated procedure, with a higher reimbursement rate, than another, cheaper procedure that is equally effective?
“I did not mean to give the impression that offering a higher level of service when warranted will get a provider kicked out of a plan. However, if a provider’s patients consistently need a higher level of service that will get noticed by an insurance company. It may well be audited. And, it will be taken into account when the insurance company is deciding whether to continue to contract with a particular provider. When you refer to this as an urban myth is it your position that insurance companies do not care whether a provider consistently bills for more services than other providers serving a similar population?”