How to get money as an acupuncturist

[Guest guest]

Hi all,

 

I was wondering how you all deal with the issue of insurance

companies. At times I spent 2 to 3 hours (which is a typical intake

time for me) only to discover their insurance won't cover acupuncture

afterall, and then they never pay me. Makes me wish that I could ask

for the money upfront and have them be reimbursed when the insurance

money comes in, but I'm not sure what they would think of that. I'm

curious to hear details about how you all run your businesses.

 

Thanks,

 

Laura

[Guest guest]

Hi Laura,

 

Insurance is frustrating at times. I am fortunate to have my wife working with

me and she calls to verify insurance coverage while I first start my

consultation with a new patient. A very good idea is to have the patient sign a

form that says that they realize that they will be responsible to pay themselves

if their insurance does not cover. If they don't want to sign - don't see them!

Why should you be the one taking the chance when it is their insurance company

that is the problem? Another thing you can do is to tell new patients that they

need to give you all their insurance information before they come in for their

consultation so you can call their insurance company in advance. Unfortunately,

many insurance companies will not pay for a consultation (or office visit), even

if they pay for acupuncture. Of course, you could also ask for payment and then

give them the necessary receipts (with your license #, diagnosis codes, etc.)

for them to send to their insurance company themselves. But, if people tell you

they can't pay upfront, then the form I mentioned above is the next best thing

although you then still have to try to get payment later. As much as people

complain about managed care, and with good reason, the one good thing about it

is you have a contract with the insurance company and know exactly what they pay

for and how much so you know where you stand. Good luck - Matt

-

heylaurag

Chinese Medicine

Friday, July 23, 2004 5:29 PM

How to get money as an acupuncturist

 

 

Hi all,

 

I was wondering how you all deal with the issue of insurance

companies. At times I spent 2 to 3 hours (which is a typical intake

time for me) only to discover their insurance won't cover acupuncture

afterall, and then they never pay me. Makes me wish that I could ask

for the money upfront and have them be reimbursed when the insurance

money comes in, but I'm not sure what they would think of that. I'm

curious to hear details about how you all run your businesses.

 

Thanks,

 

Laura

 

 

 

 

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[Guest guest]

As I see it, you have to ask for the money up front. I simply explain to

patients that we are more marginalized than doctors and therefore have much

less assurance of reimbursement. It is not feasible to take that risk of

non-payment repeatedly. But we can be ready to give receipt with codes or

fill out appropriate forms. That is why prospective patients often ask " Do

you take insurance. " Because a whole lot of practitioners don't anymore,

including doctors...for the reasons typified by your experience. I will say,

" It's not whether I 'take' insurance, but whether your carrier reinburses

for acupuncture. You will need to contact them and get an answer to that. "

I've even had prospective patients get indignant at the idea that they will

actually have to take the paper you give them and make their own efforts for

reimbursement. " I shouldn't have to do that, " was the comment of one woman.

(I think many are used to the old days when docs or clinics just did all the

paperwork and interface with the ins. companies - and their level of

reinbursement allowed that level of payment for office personnel.) The

conversation soon ended, but i took it as an opportunity to consider what

Liver formulas might have been appropriate for her ...then decided to take

some :-)

 

Ann

 

 

,

>

> I was wondering how you all deal with the issue of insurance

> companies. At times I spent 2 to 3 hours (which is a typical intake

> time for me) only to discover their insurance won't cover acupuncture

> afterall, and then they never pay me. Makes me wish that I could ask

> for the money upfront and have them be reimbursed when the insurance

> money comes in, but I'm not sure what they would think of that. I'm

> curious to hear details about how you all run your businesses.

>

> Thanks,

>

> Laura

[Guest guest]

Hi Matt,

 

I think that form is a good idea---have you found that it has

increased the likelyhood of them paying you back if insurance doesn't

cover? Also, you mentioned that " insurance often doesn't pay for a

consultation " ....which made me wonder if you do not provide a

treatment in the first visit. I would so much prefer to do the

intake on one day and the first treatment on another day. I find it

exhausting to do it all in one visit---the interview along with

coming up with a treatment plan and providing the treatment (while

you try to make a good connection and build confidence and educate

them about Chinese medicine). If so, can you tell me a little about

how you approach that?

 

Thanks so much for your feedback!

 

Laura

 

 

Chinese Medicine , " Matt Bauer "

<acu.guy@g...> wrote:

> Hi Laura,

>

> Insurance is frustrating at times. I am fortunate to have my wife

working with me and she calls to verify insurance coverage while I

first start my consultation with a new patient. A very good idea is

to have the patient sign a form that says that they realize that they

will be responsible to pay themselves if their insurance does not

cover. If they don't want to sign - don't see them! Why should you be

the one taking the chance when it is their insurance company that is

the problem? Another thing you can do is to tell new patients that

they need to give you all their insurance information before they

come in for their consultation so you can call their insurance

company in advance. Unfortunately, many insurance companies will not

pay for a consultation (or office visit), even if they pay for

acupuncture. Of course, you could also ask for payment and then give

them the necessary receipts (with your license #, diagnosis codes,

etc.) for them to send to their insurance company themselves. But, if

people tell you they can't pay upfront, then the form I mentioned

above is the next best thing although you then still have to try to

get payment later. As much as people complain about managed care, and

with good reason, the one good thing about it is you have a contract

with the insurance company and know exactly what they pay for and how

much so you know where you stand. Good luck - Matt

> -

> heylaurag

> Chinese Medicine

> Friday, July 23, 2004 5:29 PM

> How to get money as an acupuncturist

>

>

> Hi all,

>

> I was wondering how you all deal with the issue of insurance

> companies. At times I spent 2 to 3 hours (which is a typical

intake

> time for me) only to discover their insurance won't cover

acupuncture

> afterall, and then they never pay me. Makes me wish that I could

ask

> for the money upfront and have them be reimbursed when the

insurance

> money comes in, but I'm not sure what they would think of that.

I'm

> curious to hear details about how you all run your businesses.

>

> Thanks,

>

> Laura

[Guest guest]

Hi Ann--Funny comment at the end---I can relate! I agree with what

you are saying, but I am so new and desperate for business that I'm

afraid to lose the patient's who will get indignant. But maybe I

should decide that they just aren't worth it.

 

Maybe I should tell people that they need to pay for the first visit

up front, and then I will reimburse them if their insurance pays, and

after that they don't have to pay upfront (once I know what the scoop

is on their insurance).

 

Laura

 

 

Chinese Medicine ,

<snakeoil.works@m...> wrote:

> As I see it, you have to ask for the money up front. I simply

explain to

> patients that we are more marginalized than doctors and therefore

have much

> less assurance of reimbursement. It is not feasible to take that

risk of

> non-payment repeatedly. But we can be ready to give receipt with

codes or

> fill out appropriate forms. That is why prospective patients often

ask " Do

> you take insurance. " Because a whole lot of practitioners don't

anymore,

> including doctors...for the reasons typified by your experience. I

will say,

> " It's not whether I 'take' insurance, but whether your carrier

reinburses

> for acupuncture. You will need to contact them and get an answer to

that. "

> I've even had prospective patients get indignant at the idea that

they will

> actually have to take the paper you give them and make their own

efforts for

> reimbursement. " I shouldn't have to do that, " was the comment of

one woman.

> (I think many are used to the old days when docs or clinics just

did all the

> paperwork and interface with the ins. companies - and their level of

> reinbursement allowed that level of payment for office personnel.)

The

> conversation soon ended, but i took it as an opportunity to

consider what

> Liver formulas might have been appropriate for her ...then decided

to take

> some :-)

>

> Ann

>

>

> ,

> >

> > I was wondering how you all deal with the issue of insurance

> > companies. At times I spent 2 to 3 hours (which is a typical

intake

> > time for me) only to discover their insurance won't cover

acupuncture

> > afterall, and then they never pay me. Makes me wish that I could

ask

> > for the money upfront and have them be reimbursed when the

insurance

> > money comes in, but I'm not sure what they would think of that.

I'm

> > curious to hear details about how you all run your businesses.

> >

> > Thanks,

> >

> > Laura

[Guest guest]

Hi Laura,

 

Some things to remember about insurance: Even if a patient's insurance pays for

acupuncture and perhaps some adjunctive therapies and/or even office visits,

most will still have limits on what they pay, a co-payment, and a deductible.

Most people will not have their deductible met until at least March or April and

some plans will only pay $25-40 a treatment maximum. If they still have $200

deductible, you need to collect the that $200 before you start to no longer

collect from them. You should charge for the first visit, have them sign the

form I mentioned, and let them know they will get a statement (EOB) from their

insurance company when you are paid so they will know if you owe them anything

when all is said and done. Insurance is a hassle, but if one wants to maximize

their potential patient base - either to just actually make a living or, for the

few fortunate ones, to make the most money - insurance is just a part of doing

business. It is not that difficult once you learn the ropes, especially if you

are not very busy and have the time to work on it and get it down to the least

amount of time.

 

As far as your question about initial consultations goes - what we do is an art

and everyone is different. I do not try to figure everything out about a patient

on the first visit and usually take 30-45 minutes for a first consultation. I do

this because I feel I can get the basic diagnosis in less time - enough to begin

treatment - and start with just addressing the basic,major imbalances and then

see how the patient responds. I like to say that treatment is both therapeutic

AND diagnostic. Every you treat a patient, you should know more about their

condition than you did before. This approach may be more appropriate for

acupuncture than for herbs, but I have few herb only patients. I often will do

2-3 acupuncture treatments before I even prescribe herbs. This both gives me the

time to feel I fully understand their condition and gives me a better feel for

what the acupuncture vs. the herbs is doing for the patient. Again - to each his

own.

 

I sometimes liken diagnosis to a detective trying to solve a crime. You make a

list of suspects and go about gathering more evidence. As you do this, you may

later decide that your number 3 suspect is now number 1 and number 1 is now

number 4 and so forth. If you think you have solved the crime after the first

consultation, you may be less open to later see that part of your diagnosis was

off. You should always be able to know hot from cold, excess from deficiency,

interior from exterior, etc, in a very short period of time. The important finer

details can be worked out later as you gather more evidence, especially from

your previous treatments. Anyway - that how I do it. Hope this helps -

 

Why don't you write me off list and we can set up a time to talk on the phone if

you like, and I can give you more advice about the insurance issues.

acu.guy

Matt

-

heylaurag

Chinese Medicine

Sunday, July 25, 2004 1:29 AM

Re: How to get money as an acupuncturist

 

 

Hi Matt,

 

I think that form is a good idea---have you found that it has

increased the likelyhood of them paying you back if insurance doesn't

cover? Also, you mentioned that " insurance often doesn't pay for a

consultation " ....which made me wonder if you do not provide a

treatment in the first visit. I would so much prefer to do the

intake on one day and the first treatment on another day. I find it

exhausting to do it all in one visit---the interview along with

coming up with a treatment plan and providing the treatment (while

you try to make a good connection and build confidence and educate

them about Chinese medicine). If so, can you tell me a little about

how you approach that?

 

Thanks so much for your feedback!

 

Laura

 

 

Chinese Medicine , " Matt Bauer "

<acu.guy@g...> wrote:

> Hi Laura,

>

> Insurance is frustrating at times. I am fortunate to have my wife

working with me and she calls to verify insurance coverage while I

first start my consultation with a new patient. A very good idea is

to have the patient sign a form that says that they realize that they

will be responsible to pay themselves if their insurance does not

cover. If they don't want to sign - don't see them! Why should you be

the one taking the chance when it is their insurance company that is

the problem? Another thing you can do is to tell new patients that

they need to give you all their insurance information before they

come in for their consultation so you can call their insurance

company in advance. Unfortunately, many insurance companies will not

pay for a consultation (or office visit), even if they pay for

acupuncture. Of course, you could also ask for payment and then give

them the necessary receipts (with your license #, diagnosis codes,

etc.) for them to send to their insurance company themselves. But, if

people tell you they can't pay upfront, then the form I mentioned

above is the next best thing although you then still have to try to

get payment later. As much as people complain about managed care, and

with good reason, the one good thing about it is you have a contract

with the insurance company and know exactly what they pay for and how

much so you know where you stand. Good luck - Matt

[Guest guest]

Laura, I don't take insurance and I don't have any problem with the patients

that I see. On an average I see 35 - 40 patients a week and all pay cash. If

they want there insurance co. to pay I give them a form and fill in the codes

for them. They are responsible for reinbersment. I do take workman's comp. but

that can be a pain sometimes. You will over the years start a reputation as a

fine practitioner and people will come to you no matter what. Stand your

ground, treat all that come to you with compassion and understanding. They will

pay for you.

[Guest guest]

Hi Laura,

I guess I don't have much to add to what Matt has offered. The form sounds

like a decent idea. I guess you kind of have to go thru the hoops a few

times to see how it pans out, if it's worthwhile for you, if your pts have

good insurance, etc. etc.

Remember though, that even tho the pt. may pay the first time, the ins. co.

may not be forthcoming with reimbursement or even acknowledgement of the

claim's validity by the time the 2nd or 3rd Tx rolls around. Then everybody

starts to get nervous and you may feel like you have to make a concession.

It does get touchy if the pt genuinely cannot afford to pay out of pocket

for Tx. At that point you have the option of offering a sliding scale...IF

they cannot get their carrier to cover. You have the right to offer a

reduced fee, and as long as you make it clear at all times what your regular

fee is, the ins co. cannot then claim the reduced fee is now your fee, of

which they will pay their percentage, etc. But if the ins. co. pays any

amount at all, you should formally state that you still expect your complete

fee to be paid, ie. that the pt should kick in the " copay " . If they do not

pay the copay and the company discovers that fact, then that reduced fee

that you, in essence, accepted, becomes your fee as far as the ins. co is

concerned. Of course, they may never know and you cannot be expected to hire

an 'enforcer'.

 

This sounds kind of convoluted, but reflects some of the discussion that was

had when i took a seminar in collecting insurance several years ago. And

that is why many practitioners find the whole process so irksome they may

just bail and simplify by asking for some payment upfront. Otherwise it gets

too sticky. Too much time spent in each treatment simply negotiating

payment. I guess i haven't figured out how to tell in advance how good their

insurance plan is and how timely the adjuster will be about payment. I think

few of us have the turnover that allows for large blocks of time being given

away for free...especially when that is not the expectation going in. It

only takes me about 2 such experiences to change my policy. Guess that's the

limit of my patience. But for example, when an out-of-towner bounced a

check, then sent me another check that bounced, but kept assuring me that he

would pay soon, (and never did) I learned -- no more out-of-town checks.

Badda bing. (Of course, if you have a lot of o-o-t's, then you will just

have to run the risk, i guess, b/c it is, after all, a conventional method

of payment. One criteria would be their manner of referral.)

 

Ann

 

 

 

 

 

 

 

> Hi Ann--Funny comment at the end---I can relate! I agree with what

> you are saying, but I am so new and desperate for business that I'm

> afraid to lose the patient's who will get indignant. But maybe I

> should decide that they just aren't worth it.

>

> Maybe I should tell people that they need to pay for the first visit

> up front, and then I will reimburse them if their insurance pays, and

> after that they don't have to pay upfront (once I know what the scoop

> is on their insurance).

>

> Laura

>

>

> Chinese Medicine ,

> <snakeoil.works@m...> wrote:

> > As I see it, you have to ask for the money up front. I simply

> explain to

> > patients that we are more marginalized than doctors and therefore

> have much

> > less assurance of reimbursement. It is not feasible to take that

> risk of

> > non-payment repeatedly. But we can be ready to give receipt with

> codes or