Insurance Debates: Arguments Against

[Justine]

Hi-
Interesting discussion.
My opinion is that insurance for acupuncture is a bad idea, and here
is why:

1) The health care system is already overburdened. We are all
mandated in this state to pay for health ins. and it is already very
expensive. Health care is a huge expense and it is greedy to ask for
them to pay for our care which is simple and can be given to people
without costing a lot, if the practitioner chooses to practice that
way.

2) Insurance companies won't want to make acupuncture available to
people unless they charge even more. If they don't charge more, I
can't see how they'd make it available. Most people can't afford more
than they already pay for health insurance - and if they were to pay
more, then it would really be like the same thing as just paying for
acu out of pocket - but instead of the extra expense being an option,
it would be mandatory.

3) Insurance billing, coding, etc. is a huge pain to have to deal
with in a practice, day in and day out. I for one would not want to
have to deal with this, and I am willing to bet that the majority of
private practitioners won't, either. For the patients I have who can
use insurance, I hand them a reimbursement form that they submit and
that is simple enough - but it would take an entirely new job of
someone to have to work for us in our offices to deal w/ insurance all
the time.

Of course, I'm all about making acupuncture affordable and accessible
to people... so I chose a business model that does this.

I think many of your reasons are nice, ideally (that it would make
acupuncture more mainstream and "legitimate," etc.) but I still don't
think that's a good reason to have insurance cover it, nor do I think
that insurance covering it necessarily makes people think it is more
legitimate (think about chiropractors - many people are still
skeptical or don't care for it, even with it being covered - the same
would happen for us).

[Inga & Joslin Stevens]

This is a useful discussion and I don't have a solid opinion but here are a few thoughts;
 
1. Since insurance is mandatory in MA (mine is very very inexpensive) having acupuncture under the plans may be advantageous to our clients as it provides services for folks who otherwise couldn't possibly afford it. For some people there is no premium and those are exactly the clients least likely to have extra funds to pay for treatments. So in a very substantial way, insurance coverage would provide services to the poorest among us.
 
2. As for increases in insurance premiums, those in higher income brackets may feel the pinch but those in the lower brackets are not likely to incur any changes in rates so again, this is a means of serving the most under-served and likely the most needy members of our community.
 
3. A modest increase in monthly premiums is unlikely to be anywhere close to the cost of weekly treatments ($200-$300 a month).
 
4. Making acupuncture inexpensive is a luxury best reserved for practitioners who don't have a great deal of debt, children or overhead expenses. There are ways to make it more affordable but not everyone is in the same economic situation for a variety of reasons. I also think that giving a really good acupuncture treatment with thorough intake and differential diagnosis is work. It is lovely and rewarding work but none the less, it takes time and energy and it's ok to be compensated for this.
 
Just a few ideas as we continue the discussion. There is no doubt that insurance coverage increase work load and paper work enormously. It also means that insurance companies get some power in dictating length of treatment, numbers of treatment etc... It isn't a simple issue, but it may be that to survive in the current environment, we either need to acclimate or change the system. The second is a much greater challenge and may occur more effectively by doing the first.
 
Joslin Stevens




 

---

> Date: Fri, 15 Aug 2008 08:02:42 -0700
> Subject: {MA Acupuncture Insurance} Insurance Debates: Arguments Against
> From: justine...@gmail.com
> To: ma-acupunctu...@googlegroups.com

[Kate]

I would also like to add here.

Like Joslin, I don't have a solid opinion on the matter. Obviously if
more people could be exposed to and afford acupuncture services, that
would be a benefit to them. I think it goes without saying that most
of us would want that. However, not only is it a matter of much more
paperwork (an additional job really for those who are already treating
full time) but reimbursement from the health care system as it is now,
is pretty terrible. My mother is a clinical psychologist PhD and her
reimbursement rate is about 50-65% of her hourly rate and that is from
the major companies such as BCBS, Harvard, etc. So if the same were
true for us, not only would coverage take much more of our time, it
would reduce the income many have adjusted their lives around. Paying
rent, mortgage, raising kids, etc.

Another issue I have is if insurance were to mandate what treatments
(ie: specific points and herbs) would be covered for specific Western
Medical conditions. This could greatly limit our art and change the
face of acupuncture as it is practiced now in some of our clinics.

So, I am not saying I am necessarily against insurance coverage, just
playing a bit of devils advocate and saying its not completely a win
win situation. There are fairly big sacrifices that would be made on
our part. Maybe it is worth it? I don't know.

Kate



On Aug 15, 8:33 pm, Inga & Joslin Stevens <josli...@hotmail.com>
wrote:

> This is a useful discussion and I don't have a solid opinion but here are a few thoughts;
>
> 1. Since insurance is mandatory in MA (mine is very very inexpensive) having acupuncture under the plans may be advantageous to our clients as it provides services for folks who otherwise couldn't possibly afford it. For some people there is no premium and those are exactly the clients least likely to have extra funds to pay for treatments. So in a very substantial way, insurance coverage would provide services to the poorest among us.
>
> 2. As for increases in insurance premiums, those in higher income brackets may feel the pinch but those in the lower brackets are not likely to incur any changes in rates so again, this is a means of serving the most under-served and likely the most needy members of our community.
>
> 3. A modest increase in monthly premiums is unlikely to be anywhere close to the cost of weekly treatments ($200-$300 a month).
>
> 4. Making acupuncture inexpensive is a luxury best reserved for practitioners who don't have a great deal of debt, children or overhead expenses. There are ways to make it more affordable but not everyone is in the same economic situation for a variety of reasons. I also think that giving a really good acupuncture treatment with thorough intake and differential diagnosis is work. It is lovely and rewarding work but none the less, it takes time and energy and it's ok to be compensated for this.
>
> Just a few ideas as we continue the discussion. There is no doubt that insurance coverage increase work load and paper work enormously. It also means that insurance companies get some power in dictating length of treatment, numbers of treatment etc... It isn't a simple issue, but it may be that to survive in the current environment, we either need to acclimate or change the system. The second is a much greater challenge and may occur more effectively by doing the first.
>
> Joslin Stevens
>

> > Date: Fri, 15 Aug 2008 08:02:42 -0700> Subject: {MA Acupuncture Insurance} Insurance Debates: Arguments Against> From: justine.deut...@gmail.com> To: ma-acupunctu...@googlegroups.com> > > Hi-> Interesting discussion.> My opinion is that insurance for acupuncture is a bad idea, and here> is why:> > 1) The health care system is already overburdened. We are all> mandated in this state to pay for health ins. and it is already very> expensive. Health care is a huge expense and it is greedy to ask for> them to pay for our care which is simple and can be given to people> without costing a lot, if the practitioner chooses to practice that> way.> > 2) Insurance companies won't want to make acupuncture available to> people unless they charge even more. If they don't charge more, I> can't see how they'd make it available. Most people can't afford more> than they already pay for health insurance - and if they were to pay> more, then it would really be like the same thing as just paying for> acu out of pocket - but instead of the extra expense being an option,> it would be mandatory.> > 3) Insurance billing, coding, etc. is a huge pain to have to deal> with in a practice, day in and day out. I for one would not want to> have to deal with this, and I am willing to bet that the majority of> private practitioners won't, either. For the patients I have who can> use insurance, I hand them a reimbursement form that they submit and> that is simple enough - but it would take an entirely new job of> someone to have to work for us in our offices to deal w/ insurance all> the time.> > Of course, I'm all about making acupuncture affordable and accessible> to people... so I chose a business model that does this.> > I think many of your reasons are nice, ideally (that it would make> acupuncture more mainstream and "legitimate," etc.) but I still don't> think that's a good reason to have insurance cover it, nor do I think> that insurance covering it necessarily makes people think it is more> legitimate (think about chiropractors - many people are still> skeptical or don't care for it, even with it being covered - the same> would happen for us).> > _________________________________________________________________
>
> See what people are saying about Windows Live. Check out featured posts.http://www.windowslive.com/connect?ocid=TXT_TAGLM_WL_connect2_082008

[Hudson Doyle]

First, I too have doubts/concerns about accepting insurance. But on
balance I am for the option… Especially if we have a hand in
determining how it works (i.e. with state legislation).

In my experience, where I work: Many insurance plans currently cover
acupuncture, but it is not reliable across the board. Federal BCBS,
for example, covers 24 visits/year at 90%. The health plans of some
unions require a $150 deductable/year from patients, after which there
is no upper limit: they can come as much as they want for as long as
they want, and the plan covers 100%. Insurance can be very
profitable, but right now coverage is variable and spotty, not
universal (so it is unreliable, especially from an employer’s point of
view). The details of the legislation/insurance coverage we hope to
secure is very much an unknown right now—we will get to that in time—
but it is important to know that insurance reimbursement can be very
lucrative for us, cheaper for patients, and cost saving for the
government/insurance companies (as cost savings studies have shown).

It is important to see this as a move to make progress for the
profession and not necessarily for each of us individually in our
current private practice. Personally, I don’t see individual
practitioners in private clinical settings without support staff
accepting insurance—paperwork, headache, etc—it doesn’t make sense.
More so I think it will benefit the market for acupuncture services
within the medical system—i.e. for people to be employed to practice
acupuncture. Insurance billing is not something practitioners should
be doing—they should be practicing medicine, that is why I think it
would be advantageous for our services to be billable: so that clinics/
hospitals etc. can employ acupuncturists (with all the benefits of a
job—health/dental insurance, paid vacation etc.) and leave them to do
the billing. Reimbursement might very well change the face of the
setups in which acupuncture is practiced.

If we, as a professional organization of acupuncturists lobbying for
our own interests, do not have influence over this we will likely lose
out in the end. For I think it is inevitable that insurance coverage
for acupuncture will expand. And better we shape the policies than
those who do not hold our interests.

No individual is obliged to accept insurance. If you already have a
successful private practice, why change? But insurance coverage
will, I believe, expand the profession/the medicine into other sectors
of the healthcare system and benefit many up and coming practitioners
looking to develop successful, lucrative practices. Furthermore, if
you give receipts to some people so they can get reimbursed, would it
be difficult to give receipts to everyone so everyone could be
reimbursed? As practitioners who give receipts now know, insurance
need not require the provider to do any paperwork. It need not be so
complicated, but it depends on what we are able to create.