That’s It—No More Insurance Filing

Acupuncture Works, having had an aversion to insurance filing for a long time, will absolutely no longer file insurance for payment. No exceptions. Maybe this policy warrants some explanation for those who may be unsure about why an acupuncture practice would seemingly turn away good business over such a pesky detail. Please read on.

Most patients pay at the time of service. I can only think of two times in the past three years that people came to me with approvals, in writing, from their major health insurance companies, for coverage of acupuncture at  this facility. In both cases, the insurance companies later refused to pay. Their final refusals took place after many months (not days or weeks -- months that I am waiting to get paid) of correspondence via phone calls, faxes, and mail. Ultimately, when this occurs, the bill is still outstanding and needs to be paid. This involves an uncomfortable conversation between the service provider (me) and the person who received the service, usually months before, but felt that they should not have to pay for it, because it was supposed to be covered. Tension ensues, and either the patient (usually reluctantly) pays the money or the case is turned over to a third-party collection agency. The collection agencies charge a large percentage of any amount they can recover, which makes it impossible for this facility to negotiate a settlement with the patient at a discount once it has gone that far. All things considered, it's a negative situation for everyone. Why is this so?

1) The acupuncture office is not the client of the insurance agency, the patient is. That being the case, they have no obligation to appease me by settling the case at all, much less in a timely manner. It often takes months to come to any resolution. The insurance companies may work on behalf of their customer, the patient, but even then there is no real motivation on the part of the insurance company to pay, and from my perspective most of them will do anything to avoid paying. 

2) If the patient will pay the acupuncture office upfront and take the provided superbill to their insurance company for reimbursement, they have a better chance of having the visit(s) covered and I get to stay blissfully out of it. The insurance companies in some cases will indicate a lack of awareness that the patient has already paid, and they will often contact me to try to negotiate an "expedited settlement", offering me maybe 50% of  the fee to settle the bill 'quickly'. Nothing makes me more satistfied than to tell them that the patient has already paid their bill in the full amount charged and that the settlement offer does not apply. Ha! I have also been known to tell them that this is my income that they want me to negotiate on, and how would they like to have their paycheck negotiated down so they can get it faster? No answer. 

3) After the patient has been asked to pay a bill that they thought was covered, there is tension around future acupuncture visits on both sides. I want to treat the person but I also want and deserve to be paid for my work. They may resent that they are being asked to pay for something they shouldn't have to pay for. I'm not rude or pushy by nature, but these situations can get testy. 

Worker's Compensation and MedPay claims from auto insurance are ok. I do see payments from these cases so they are welcome. But to avoid any more of these situations with health insurance that, in reality, take up energy and time that could be used to treat people and learn more about this beautiful art af acupuncture that I am engaged in, I am not seeing anyone else who just wants to pay a copay, walk out the door, and have me file their insurance company for payment of the rest of the bill. This includes Medicare, which does not cover acupuncture. Even if your insurance agent comes with you and looks me in the eye and guarantees me that I will get my money right away. I have seen enough by now that I do not believe them. If acupuncture is said to be covered by your health insurance policy, please find somewhere else to go. It's not worth it to me. 


Kerri Winston, Ph.D., L.Ac., is a licensed acupuncturist with a practice in Atlanta, Georgia's Buckhead area. If you are interested in learning more about how acupuncture can help you or your loved ones, please call 404-949-0550 or send email to [email protected].