We now accept Medicare plans for Acupuncture visits!
In January 2020, the Federal government made a groundbreaking exception for Acupuncturists to bill Medicare. After years of volunteers' fighting, we were finally, partially, accepted. Congress saw all the proof, which was summed up in a 200-page document of the research behind Medical Acupuncture and its efficacy for low back pain. Unfortunately, Congress couldn't grant us our own ability to bill directly to Medicare just yet but made an exception for us if we bill under a Primary Care Provider.
Evergreen Medical Acupuncture (EMA) began its journey to be the first acupuncture clinic in Colorado to take Medicare at the beginning of 2021. We finally got approved in 2023! Now, it's not perfect as we can't accept every policy, but for the most part, we can take a lot of Medicare plans.
What conditions will Medicare cover?
Medicare will only pay for chronic low back pain. However, that can include regular back pain, sciatica, and hip pain associated with low back pain. Medicare will not cover low back pain that is from cancer pain/metastasis.
How many visits annually?
If approved, you will get 12-20 treatments.
Which policies are covered? What is your cost?
This is the million-dollar question. All traditional Medicare Part B policies are guaranteed to be covered only if that is your only Medicare plan. If you also have a Supplement or Advantage plan, the rules change. If Medicare Part B is your only plan, your copay is $0 for all 20 treatments after you meet your deductible!
If you have a Medicare Supplement Plan, which is your secondary insurance, we bill that plan first, then your Medicare Part B will pick up what your Supplement doesn't. Typically, these Supplement plans have to follow Medicare guidelines which means patients also have a $0 copay and get up to 20 treatments per year, but not always. We verify everyone's plan to ensure we are giving you accurate information.
If you have a Medicare Advantage Plan, listen closely! People can have all kinds of Advantage plans usually from places like United Healthcare or Cigna that do not necessarily have to follow Medicare guidelines. The catch here is that EMA is out-of-network (OON) with all of these insurance companies and we must bill your Advantage plan first and as primary. There are two kinds of Advantage plans: PPOs and HMOs and it is very important you look on your Advantage Plan card to see which one you have. If you have an HMO, again because EMA is OON with all insurance carriers (like United, Cigna, Anthem, Aetna, AARP, etc) that means that you will not have any, I repeat zero, Acupuncture benefits with us. If we get in-network with one of those companies then we will have the ability to bill these HMO policies, but it takes many months to get in-network anyway. But for now, if you have an HMO Advantage plan, we know for a fact, there are no acupuncture benefits for you, we are so sorry!
Now, if you have a PPO policy, that's where the fun begins. Basically, you may or may not have benefits and the only way we can tell is if we verify your policy through our third-party company. With policies like these, some patients have a $35 copay up to a $70 copay which is all billed as OON (again, because EMA is OON with Untied, Cigna, etc). However, even $70 is cheaper than $95 per treatment!
We have this neat feature on the front page and "Insurance" tab of our website where, regardless if you are a current or new patient, you can verify your insurance benefits right from home. Give us a few days and once the information is in our system we will call or email you what your benefits are.
You will also find more in-depth information about Medicare and insurance on our website. As always feel to call us, but most info should be available on our website.
We understand that it isn't ideal that we cannot take every Medicare-type policy. However, I want to reiterate how groundbreaking it is that Acupuncturists are now allowed to take Medicare at all. Please know that in order for a private Acupuncture clinic like EMA to take Medicare, we need a Medical Director who is a qualified Medical Doctor to become an employee of the business, many different lawyers, billing specialists, hiring specialists, working with the State of Colorado (DORA), and hiring internal help to be able to provide a benefit that is free (or close to) to you! It took over one year for EMA to go through just the application process once we had all of that! So please be patient with us as we are one of the first clinics in the entire country to be able to bill your Medicare Policies.
This project has been near and dear to my heart and I personally have spent (as many of you know) thousands of hours including my weekends getting our clinic in with Medicare! So if you or someone you know struggles with back pain and has Medicare, we would love to treat you! Acupuncture, without a shadow of a doubt, can help your back pain!
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