Most days of the week, as an acupuncturist in central Vermont, I am asked if health insurance covers acupuncture. As with any choices that we each make, finances have to be considered when deciding about our health care. When paying the premiums for your insurance each month, you hope that your plan will pay for the treatment option that you seek. Whether this is for a specific medication, imaging, a surgery, or a complementary therapy, you may be happily surprised or quite disappointed when you call the number on the back of your card to see if it will be paid for.
Insurance Reimbursement for Complementary Therapies?
Each insurance company within each state will offer different plans and benefits. In Vermont, acupuncture is not a covered service for most plans. A large employer can craft its own plan and select which specific benefits to offer its employees. If you happen to work for the state of Vermont, you have a plan that includes acupuncture with no limited number of treatments and no limited reasons for seeking care. Other larger companies like UPS or Green Mountain Power also include acupuncture. If you work for the federal government, you also have coverage, with a limited number of visits per year. A referral from your primary care provider is not needed. There may be a co-pay of $20 or $25, which makes needed treatment much more affordable.
Naturopathy is covered by most plans. A naturopathic physician can be chosen as your primary care provider and will bill the same as most doctors’ offices in Vermont. Please speak to your provider directly before care begins to be clear on what to expect for payment.
Chiropractic care is also a commonly covered service in Vermont health insurance plans. Medicaid allows for ten visits per calendar year and anything beyond that would need prior approval. Other plans through the health exchange typically offer up to 12 visits to your chiropractor before prior approval is needed.
If you are seeking massage therapy, don’t expect to have any help from your standard health insurance plan. If you have a plan coming from another state, you’ll have to contact them directly to see about possibly coverage for massage.
Workers’ Compensation and Auto Liability Insurance
For most complementary therapies, including acupuncture, if there is a referral from your primary care provider it will most likely be covered in workers’ compensation claims and auto liability situations. At the initial evaluation with the acupuncturist, massage therapist, or chiropractor, the practitioner will suggest a certain number and frequency of visits which will then hopefully be approved by the insurance company.
Of course there are other common complementary therapies to consider like yoga therapy, homeopathy, and reiki, which most health insurance plans will exclude. Again, the practitioner will be the best one to talk to about this before beginning care.
Legislative Efforts
There are currently active legislative efforts in Vermont within these professions to secure insurance coverage for these forms of medical care. This is ultimately to make these various health care options more accessible to all Vermonters. If you’d like to learn more about and support these efforts for insurance reimbursement for all or any of these complementary therapies, please contact me to guide you.