According to the National Center for Health Statistics, about a third of Americans use some form of complementary or alternative medicine (CAM). Americans spend more than $30...
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According to the National Center for Health Statistics, about a third of Americans use some form of complementary or alternative medicine (CAM). Americans spend more than $30 billion annually out-of-pocket on everything from acupuncture to Zyto scans. Despite those billions of dollars spent on CAM therapies, many are not covered by health insurance.
In the most recent study, most of these out-of-pocket expenses (over $14.7 billion dollars) went to CAM therapies such as acupuncture, chiropractic care and massage. We spent another $12.8 billion on natural products, and $2.7 billion on self-care approaches, such as wellness books and homeopathic medicines.
According to the National Institute of Health (NIH), the most commonly covered CAM therapies include acupuncture, chiropractic care and massage. Non-covered CAM therapies generally include herbs and supplements, homeopathy, kinesiology, and naturopathy. Though these procedures may not be covered, alternative healthcare costs could be reduced if policyholders better understood insurance policies and options, taking advantage of covered CAM therapies.
Many self-insured plans (insurance through employers) offer coverage for a variety of CAM therapies; however, policyholders are often unaware of these benefits and don’t know where to look for coverage information. To make matters more complicated, insurance companies will often require diagnosis and procedure codes before they can confirm coverage.
Most CAM providers do their best to verify coverage in advance. However, we’ve had patients come to us from other clinics with stories of being hit with big bills later because their insurance company verified coverage or listed it in the policy manual but failed to mention coverage was limited to specific health conditions or was only partially covered. Being told "yes" to a benefit but not being told about restrictions or limitations leads to large and unexpected out-of-pocket costs that might have been avoided were more detailed information given or obtained.
Having the correct diagnosis and procedure codes handy when calling insurance companies and asking about specific restrictions is vital to proper verification, and even then, there are challenges. Like many CAM providers, we've hired a CAM billing expert to handle verifications and billing for our practice (it's that complex).
To paint a picture of how convoluted the process can be, here are a few of the more frustrating restrictions on acupuncture we've seen through our verification process:
Unlimited acupuncture visits. Seems straightforward enough right? Nope, after the claim was denied it was revealed that acupuncture was only covered when provided in lieu of anesthesia for a covered surgery and only when performed by an anesthesiologist. Seriously? Who would even think to ask about such a restriction. Is there even a hospital in the US that would allow it? And who who want it? Not that I am aware of.
I'm an acupuncturist and I'd prefer not to be put 'under' for surgery with acupuncture and quite frankly, I wouldn't even know how to do that. Over the years I've seen this one quite a bit, which is why our billing agent specifically asks about this restriction.
We've never been able to get a solid answer on why this restriction is written into policies as it seems to violate the spirit of the benefit, but this is a battle policy holders will have to fight (and should).
Only one acupuncture visit allowed per year. While it's nice that acupuncture was offered on this plan, the benefit is nearly useless. It's much like providing a single antibiotic pill and wondering why the infection didn't clear up. Acupuncture, while an effect therapy, is unlikely to produce total resolution of any health issue with a single treatment.
An acupuncturist cannot provide acupuncture. Another restriction we've seen is acupuncture only being covered when performed by a dentist (yes, really) and some policies will only cover it of it's provided by an MD and on others only by a chiropractor and on a few occasions it was limited to a physical therapist. Because of this, our billing agent always asks if the acupuncture is covered when performed by a licensed acupuncturist because this information is rarely provided without the question being asked.
Such restrictions may be a violation of The Non-Discrimination in Health Care provision, section 2706 of the Public Health Service Act as added by the Affordable Care Act, expands the types of specialty services that health plans cover. As of January 1, 2014, complementary and alternative medicine (CAM) providers can submit claims on behalf members for services that are:
Covered by the member's plan,
Within the scope of their licensure/certification as defined by the state statues, and
Medically necessary in accordance with state statutes.
Coverage will be based on the member's existing plan benefits and all other terms of the member's plan, including but not limited to medical and payment policy criteria.
The provision applies to all plans that include the changes mandated by the Affordable Care Act for 2014. It doesn't apply to Medicare Advantage, grandfathered, or transitional plans. Note: In November 2013, federal and state governments allowed members with small business and individual plans to keep their existing plans for 2014. These transitional plans don't include the law's new coverage requirements. Coverage Codes for Affordable Care Act lists coverage codes for all medical plans that cover benefits rendered by CAM providers.
No insurance coverage? One option for obtaining coverage for alternative medicine costs is through a Health Savings Account (HSA), Flexible Spending Account (FSA) or Healthcare Reimbursement Account (HRA). For more information on these options, visit: https://www.consumerreports.org/healthcare-costs/how-to-use-fsas-hsas-hras-to-cut-healthcare-costs/
The good news is that each year more insurance companies are covering evidence-based CAM therapies. There are bound to be glitches and complications as the healthcare industry adjusts, adapts and grows. Be patient, do your research, challenge policy restrictions that don't seem right, call your congressman or representative. Change is happening but only because Americans are reaching out and making their voices heard.
Usually because the number and frequency of treatments needed would not be cost-effective when compared to other options available to the patient, or I have no expection of resolving or improving the condition.
First, we don't treat cancer. Acupuncture is not a cure for cancer. We do however, use acupuncture to reduce the side effects of cancer therapies such as chemo or radiation, improve appetite, increase energy, boost the immune system, etc. In a nutshell...I would not recommend acupuncture to treat cancer, but I would recommend it to support the patient during cancer treatment.
If a frail and weak patient came in and wanted treatment for a chronic illness, I may not take the case because it might be too draining for them. I won't take a case unless I have a reasonable expectation of restoring function or improving quality of life. If it's going to take me 20-30 sessions multiple times per week to provide a small measure of improvement, I would not recommend acupuncture. Though if I thought I could significantly improve their condition in 20-30 treatments, I would likely accept them as a patient.
I also do not recommend acupuncture for smoking cessation in those who do not wish to quit and are only coming because family, work or a doctor has pressured them into quitting. Stopping the cravings is the easy part, changing the habits that have formed over many years requires willpower homework. It's not the cravings that are difficult to overcome...it's the emotional attachment to nicotine. I would not recommend acupuncture for addition in those who are not ready to quit and seeking a little extra support.
There are more than 9 types of headaches and 10 types of migraines. Each with their own unique cause. There is NO one single acupuncture point for that. In fact, if you look at a chart of the ear, you will notice that the points in that area are unrelated to such things. At most you might improve your digestion.
This type of piercing is a common topic of discussion in the acupuncture community because we cannot figure out where such a false claim came from. At first we were excited to find a new way to help our patients, but it turned out to not be true.
If I could cure a migraine with one point/piercing I would. I’d have many happy patients, a line around the block and I'd be very wealthy. Unfortunately, there is no such point. For some, there is a mild placebo effect for a time. That alone is worth trying it; the mind is, after all, a powerful tool of healing.
I have heard a few local piercing artists heavily promote this and speak with great “authority”. However, when I asked them where they got the info that 5,000 years acupuncture failed to discover, they were unable to provide me with information other than “it’s what I was told” or “Google.” Or “I read an article.” Or my favorite “It’s in a research journal article.” They can never quite recall which one, which is no surprise.
To effectively address migraines, numerous points are involved and should not be left in permanently. Also vital to treating migraines is addressing the root cause, which could be hormone imbalance, nutritional deficiencies, food allergies, a neurological disorder, a tumor, a stress reaction, cervical spine injury or even a side effect of a medication. These underlying causes must be factored into to a treatment plan or the migraines will continue.
Here is my go to protocol for Cold & Flu Prevention
One of the greatest contributions Chinese medicine offers the West is the availability of herbs and herbal formulas that directly attack viral infections causing the common cold, influenza, upper respiratory infections and other viral infections such as shingles. When it comes to viral infections Western medicine is at a total loss, offering at best bed rest and fluids, and at worse, antibiotics.
Why do I say worse? Antibiotics work on bacteria and are essentially ineffective against a virus and do nothing to alter the time frame of an infection, Antibiotics can however, negatively impact the body’s immune system. Antibiotics destroy as many as five hundred different species of beneficial gut bacteria and promote the growth of the fungus Candida Albicans (yeast.)
Why Try Chinese Antiviral Herbs? In a nutshell, over the counter (OTC) medications don’t cure the flu but they can help you feel better by treating symptoms such as aches, coughs, and sore throats. Antibiotics do NOT work against the flu because it is caused by a virus and not by bacteria. Tamiflu can be dangerous and has side effects many wish to avoid.
CHOOSING AN ANTIVIRAL
When it comes to cold or flu that start as a sore throat and then moves into nasal congestion and muscle aches, the medicine of choice is YIN QIAO JIE DU WAN. This formula works best when taken in the first 10-12 hours of a wind heat presentation and is an effective preventative when the slightest symptoms of scratchy throat or headache appear, often stopping a cold or flu in its tracks, making it a must-have for teachers!
Already Have a Cold or Flu? GAN MAO LING is perhaps the most useful product when a common cold is developing beyond the help of YIN QIAO JIE DU WAN and the symptoms of sore throat, sinus congestion, muscle aching, headache or slight fever are more severe. Almost 70% of this formula consists of three herbs. These three antiviral herbs are so powerful they have received a fair amount of attention by Chinese researchers and clinicians.
My personal favorite is CHUAN XIN LIAN. Another powerful, three-herb combination is good for severe sore throat and I would also recommend it for acute hepatitis and even shingles outbreaks. It’s my go-to for anything angry, red or swollen be it viral or bacterial.
Ban Lan Gen (Isatis root) is the main antiviral used in several of the formulas and is helpful when used as a preventative. You can drink it daily in a ‘tea’ and it tastes a bit like honey.
What Chinese Antivirals Should I Buy? All of them! Keep a supply handy at home because remember, a cold or flu will go from first symptom to full-blown in a matter of hours and it’s best to shut it down before it has a chance to start rather than focus on treating the symptoms and trying to boost the immune system to recover faster. Prevention is the key.
Pesticides. The secret ingredient in Chinese herbs. Traditional Chinese herbs have a strong reputation for their medicinal benefits, but a Greenpeace East Asia investigation has revealed that many of these herbs are coated in a toxic cocktail of pesticide residues, posing long-term health risks instead. We caution against purchasing inexpensive, off-brand Chinese herbal formulas as Asia markets or online or even reputable brand purchased from Amazon or other online marketplaces due to the high probability of inadvertently purchasing a counterfeit. At East Lake Acupuncture we are very selective about the manufacturers we buy from and each is well-researched. If you wish to purchase herbs or supplements online we are happy to set you up with a Wellevate account, which will give you access to hundreds of your favorite brands from a distributor you can trust.
The needle are usually retained 30-60 minutes.
There is no way to predict how long the effects will last. It depends on the reason for your pain, the underlying structure involved (muscles and spine) and the method of acupuncture used.
A single treatment is unlikely to produce total resolution of a health issue. As the treatments accumulate the results last longer. A neuro surgeon once told one of my patients that after a course of treatment (anywhere from 6-12) acupuncture is a bit like taking a vicodin that last for weeks. That was a great way to describe it. Wouldn't it be great to get to the point where you only needed one pain pill (or acupuncture session) ever few weeks?
-Achy or heavy sensations
-Twitches or spasms (generally painless)
-Itching and tingling, especially on the nose
-The sensation of something (qi) moving around through the body
-Feelings of peacefulness or even euphoria
-Strong emotions. Crying, happy, sad, mad, giggling (let it all out)
-Feeling sleepy and relaxed
-An occasional bruise or tender spot
-A red spot (histamine response) where some of the needles were (painless and don't itch)
-Mid- and/or post-acupuncture itching (feel the qi moving!)
It's also normal for pain levels to fluctuate a bit at first, so it may seem like there is a "flare-up," but generally, it's considered normal and a sign of change, and change is good.
As far as what if acupuncture is performed incorrectly (very rare if performed by a licensed acupuncturist), there are some rare complications that could happen such as pneumothorax (punctured lung). This is very rare due to both the small size of modern needles and the anatomy understanding of the acupuncturist. Though I've heard of a case in Canada and one in the UK (both times the acupuncture was performed by a massage therapist and not an acupuncturist). I heard about a case in Korea where a needle was inadvertently left in and worked it's way into the lung and was removed with surgery. I was always suspicious of that story as such an event is unlikely, but I suppose it would be possible. The other complication that could happen is called a "stuck needle" which is where the needle gets stuck in the fascia. This happens for two reasons: 1. The needle is rotated during treatment (this is normal) and somehow gets caught in the fascia which doesn't seem to want to let go or 2. The body simply wants to hold onto it little longer. This resolves by leaving the needle in place a few more minutes or inserting another needle next to it to release tense fascia or muscle. I've only ever had this happen once in my career and I was able to get it to release by rotating the need the opposite direction and gently tapping the skin near the needle.
Fainting is another rare side effect. I've had this happen four times in 7.5 years and 3x the person had diabetes, was nervous about treatment and hadn't eaten for several hours prior to treatment. I realize these things are all alarming, but I cannot stress how rare and unlikely there are and millions of treatments are given around the world each year without any adverse effects.
Lifestyle and dietary changes are generally necessary to see longterm change. I don't recommend stopping any medications without first speaking with your doctor.
If you want to address a health condition a single treatment here or there is unlikely to produce a total resolution of a health issue. A commonly used explanation likens treatment to pushing a car out of mud. One push and the car rocks out a little but settles back into the mud. However, enough pushes and the car gains the momentum needed to move out of the mud and back onto the road. As the treatments accumulate, momentum begins and you may find other symptoms you thought were unrelated also resolve.
Here is the standard guidelines for a course of treatment of acupuncture. I hope this helps.
Evidence-based treatment guidelines
Course of Treatment Based on Peer Reviewed Clinical Coverage Guidelines Devised by Centers for Medicare and Medicaid Services (CMS), National Coverage Determination for Acupuncture and Foundation for Acupuncture Research. Acupuncture and electroacupuncture.
Normally an initial course of treatment consists of 12 to 18 treatments over a 4 to 6-week period, depending on complicating factors. For acute conditions, fewer treatments may be necessary to observe a therapeutic effect and to obtain complete recovery. For chronic conditions, such as in this case, and in conditions with complicating factors, extended treatment is recommended to observe response to treatment.
As in most types of therapy, the earlier the patient receives treatment, the greater the probability of recovery, and the shorter the time to recovery. Acupuncture is commonly utilized in chronic conditions because of effectiveness in pain management and limited treatment options. However, it should be noted that acupuncture and electro-acupuncture can lead to complete recovery in many NMS conditions when it is offered in the acute and sub-acute stages of injury, particularly when used in conjunction with other therapeutic interventions, such as range of motion (ROM) and strengthening exercises and manual manipulation of the soft tissue.
Acupuncture or electroacupuncture are rarely performed as a single treatment, but are usually prescribed and performed as a series, or "course of treatments." Thus, treatment planning requires a recommendation for the number, frequency, and duration of treatments that is appropriate based upon the nature and extent of the injuries and the prognosis for a progressive and timely recovery from those injuries. Severe injuries, multiple injuries, metabolic disorders, and other complicating factors may require more frequent treatments over a longer duration of time. For example, while some multiple injuries can be treated simultaneously, others must be treated independently and sequentially, requiring increased treatment frequency.
Recommended Additional Course of Treatment
A conservative recommendation of a series of 12 additional visits are recommended. Treatment based on medical necessity shall be determined at time of service based on subjective complaints and observations.
Re-Evaluation: A detailed or focused re-evaluation designed to determine the patient's progress and response to treatment should be conducted at the end of each course of treatment. Additionally, a brief assessment of the patient’s response to each treatment should be noted after each treatment is completed, and again before the next one is started, and recorded in progress notes (e.g., SOAP notes). When a patient's condition is not responding to treatment for a period of 2 to 3 weeks, a more thorough re-evaluation should be conducted immediately to determine if the condition is different or more serious than the initial diagnosis had indicated and/or whether the condition requires further diagnostic testing and/or referral to other diagnostic or treatment specialists.
Follow-up courses of treatment may be similar in frequency and duration to the initial course of treatment. However, one of the goals of any treatment plan should be to reduce the frequency of treatments to the point where maximum therapeutic benefit continues to be achieved while encouraging more active self-therapy, such as strengthening and range-of-motion (ROM) exercises, and rehabilitative exercises. The frequency of continued treatment generally depends upon the severity and duration of the condition; treatment benefits are generally stronger and last longer as a condition moves from acute towards complete resolution and as the patient takes a more active role in his or her recovery.
• Acute - 2-3 treatments per week for 4 weeks, decreasing frequency as symptoms resolve and are reduced. Reevaluate after 12th visit.
• Sub-Acute - 2-3 treatments per week for up to four weeks. 1-2 treatments per week thereafter for up to 6-8 weeks. This is also the time when a rehabilitation exercise program is usually introduced. Reevaluate after 12th visit.
• Chronic – 12 visits, 1-2 treatments per week for 6-8 weeks. Reevaluate after 12th visit.
• Recurrent/Flare-Up - 1-2 treatments per week for 6-8 weeks. Reevaluate after 12th visit.
Acupuncture is considered medically necessary for the following indications:
• As a treatment for acute or chronic pain, including postoperative, musculoskeletal, neurogenic, vascular, craniomandibular, and malignant pain; OR,
• For postoperative nausea and vomiting (including children); OR,
• For morning sickness associated with pregnancy; OR,
• For chemotherapy-associated nausea and vomiting
The Acupuncture Clinical Guidelines/Plan of Care Recommendations - Peer Reviewed: 1. Hayes Directory. Acupuncture for Pain. January 20, 2005.2. Hayes Directory. Acupuncture and Acupressure for the Treatment of Nausea and Vomiting. June 20, 2005.3. Hayes Directory. Acupuncture for Treatment of Addictive Behavior. May 31, 2005. Government Agencies, Professional and Medical Organizations: 1. Centers for Medicare and Medicaid Services (CMS), National Coverage Determination for Acupuncture (30.3)2. Centers for Medicare and Medicaid Services (CMS), National Coverage Determination for Acupuncture for Fibromyalgia (30.3.1)3. Centers for Medicare and Medicaid Services (CMS), National Coverage Determination for Acupuncture for Osteoarthritis (30.3.2)4. Council of Acupuncture and Oriental Medicine Associates (CAOMA), Foundation for Acupuncture Research. Acupuncture and electroacupuncture. Evidence-based treatment guidelines. Calistoga (CA): Council of Acupuncture and Oriental Medicine Associates (CAOMA); 2004 Dec.