Fwd: [AACBoard-AnnounceList] Hinchey Bill

[Guest guest]

Passing the Medicare bill will result is all compensation for acupuncture

becoming as low as our new codes. For those that have not experienced the

new rates you will receive $17 per half hour of direct patient one to one

care. If you what this to be the future of OM support the bill

 

 

[Guest guest]

Medicare coverage does not mean insurance coverage. Insurance companies

will most likely pay at or near similar rates. Passage will mean that more

will be forced to cover acupuncture. This could be the break we are looking

for.

>>>Your statement is somewhat naive because as medicare goes so do other insu,

although with the new codes it may not make any difference. Except that you may

not charge a medicare patient above the covered amount (unless you will not join

medicare) and which again would probably mean working for $35 per/hr.At least

with privet insu you can say that you do not take insu and therefore charge what

ever you want and just give a receipt to the patient. At the same time most

newer practitioners would probably not get away with that as more and more

patients will demand to be treated with insurance billing, especially medicare

patients.

 

 

 

 

[Guest guest]

" Dr. Phranque " <wrighttothepoint wrote:To:

AACBoard-AnnounceList

" Dr. Phranque "

Sat, 12 Feb 2005 05:00:36 -0700

[AACBoard-AnnounceList] Hinchey Bill

 

 

Members,

 

The following was sent to us from the AAOM concerning the Hinchey Bill. At

the last General Meeting, the membership voted in favor of AAC endorsing

this bill. If we want this to pass, we need to be active, Please read the

following and help us get recognized nationally.

-P-

 

 

February 9, 2005

 

Hinchey Bill Reenacted

 

Dear AAOM Members and Friends:

 

The Medicare Bill authored by Congressman Maurice Hinchey is being reenacted

this spring.

 

The time is now. We must strike while the iron is hot. Please have your

patients, friends and colleagues write letters to their local

representatives. This is about freedom of right to choose medical services.

Every American should be able to select acupuncture as a reasonable,

evidence based, and cost effective solution. We must stand together for that

which we all believe. That is, the right for all people to choose their

manner of health care, and particularly acupuncture.

 

In the face of the unnecessary deaths proffered upon the American public

through the unfortunate authorization, marketing and promotion of dangerous

drugs such as the cox2 inhibitors, it now becomes our moral obligation to

emphasize wherever we can about the growing body of evidence for the safety

and efficacy of acupuncture and oriental medicine such as osteoarthritis of

the knee and the lower cost treatment of headaches. Since there is no longer

a question of “does acupuncture work?Ewe must now to relay to the public

the importance of the rights and privileges to access to this particular

body of medicine.

 

Thank you for your prompt attention to this urgent concern. The AAOM remains

committed to the professional practice of Acupuncture and Oriental Medicine

and every voice counts. Let’s work together to achieve victory for the

American access to Acupuncture and Oriental Medicine.

Update on Federal Acupuncture Coverage Act

 

Dear Friends,

 

In response to a legislative rider that Congressman Hinchey added to an

appropriations bill late last year, we have received a report from the

Office of Personnel Management (OPM), the agency that oversees the Federal

Employees Health Benefits (FEHB) program, on insurance companies' voluntary

coverage of acupuncture services.

 

Though federal law does not mandate that acupuncture services be covered by

FEHB-contracted plans (which Congressman Hinchey's legislation would

change), we have suspected for some time that insurance companies are

voluntarily adding acupuncture benefits to their packages for federal

employees. In light of the growing coverage for acupuncture in the private

insurance market, it seemed likely that these same insurers would make

comparable benefits available in their FEHB policies. The provision of extra

benefits (those not mandated by law, including dental and vision care) is

quite common and is a tool that insurers use to make their plan more

attractive than their competitors' plans.

 

According to the OPM report, about one-fourth of all plans offered under

FEHB include some acupuncture coverage. Since acupuncture coverage is

included in several national fee-for-service plans (American Postal Workers

Union plan, Association Benefit Plan, Blue Cross/Blue Shield and GEHA, among

others), the percentage of the federal work force that is covered by plans

offering acupuncture is nearly 75 percent.

 

Of the 58 plans offering some level of acupuncture coverage, only 31 plans

specify that services may be provided by a licensed or certified

acupuncturist or a doctor of oriental medicine. Thirteen plans only cover

acupuncture services if provided by a doctor of medicine or osteopathy. The

remaining 14 plans did not specify which providers of acupuncture would be

covered. These results underscore the need for passage of Congressman

Hinchey's legislation, the Federal Acupuncture Coverage Act, which would

guarantee that every FEHB plan would include acupuncture coverage and also

would ensure that licensed acupuncturists would be covered providers under

every plan.

 

Although OPM did not provide us with the plan-by-plan report that we

intended, I have conducted my own analysis of acupuncture coverage within

the plans. I have included my results in the attached spreadsheet, which you

are welcome to share with your members and others in the acupuncture

community. I have also included a copy of OPM's response.

 

Congressman Hinchey's legislative rider also required that OPM provide an

assessment of the cost to FEHB of adding a mandated acupuncture benefit. We

believe that, if conducted fairly, OPM's analysis will show a net savings in

health expenditures when federal employees can choose acupuncture treatments

instead of medical procedures. We expect to receive the second report in

late March.

 

In other news, Congressman Hinchey is preparing to re-introduce the Federal

Acupuncture Coverage Act on February 15. The following 22 Members of

Congress have committed to co-sponsoring the bill so far:

Abercrombie, Neil (D-HI)

Ackerman, Gary (D-NY)

Conyers, John (D-MI)

Farr, Sam (D-CA)

Filner, Bob (D-CA)

Frank, Barney (D-MA)

Jackson-Lee, Sheila (D-TX)

Jefferson, William (D-LA)

Kildee, Dale (D-MI)

Kucinich, Dennis (D-OH)

Lantos, Tom (D-CA) McNulty, Michael (D-NY)

Miller, Gary (R-CA)

Nadler, Jerry (D-NY)

Royce, Ed (R-CA)

Sanders, Bernie (Ind-VT)

Schiff, Adam (D-CA)

Towns, Ed (D-NY)

Waxman, Henry (D-CA)

Wolf, Frank (R-VA)

Woolsey, Lynn (D-CA)

Wynn, Al (D-MD)

 

Best regards,

 

Wendy D. Darwell

Chief of Staff

Office of U.S. Rep. Maurice Hinchey

2431 Rayburn House Office Building

Washington, DC 20515

(202) 225-6335 (phone)

(202) 226-0774 (fax)

 

Addenda:

 

For your use in practice building, legislative efforts, and patient

communications, the AAOM has provided the list below of evidential bases for

the practice of acupuncture.

 

The literature shows acupuncture’s effects on most organ systems including

respiratory conditions, such as attenuation exercise induced asthma (Lancet)

and diminished bronchoconstriction in clinical asthma attacks (Annals of

Allergy). Obstetrics and gynecology evidence demonstrates relief of pain in

labor and delivery (Anesthesiology), aids in the induction of labor

(Obstetrics and Gynecology), controls morning sickness (Obstetrics and

Gynecology 11/92) and treatment for infertility (Gynecology and

Endocrinology 9/92). In the genitourinary area, treatment of renal colic,

acupuncture demonstrated more rapid response than contemporary treatment

(avaforton) and with no side effects (J Urology 1/92). In the

gastrointestinal region, acupuncture relieves GI tract spasm, which failed

medication (Lancet), acupuncture decreased in peri-operative nausea and

vomiting has been demonstrated through peri-operative acupuncture (British

Medical Journal, Anesthesiology News), it prevented nausea and vomiting in

laproscopic patients (Acta Anaesthesia Scandinavia 2/93). Cardiovascular

system acupuncture led to reversal of CV arrest in experimental animals

(Journal of Surgical Research). Wound healing acceleration of wound healing

through electro-acupuncture has been demonstrated (Archives of Physical

Medicine & Rehabilitation), accelerated skin ulcer healing (Southern Medical

Journal) and augmentation of bone repair Science). Sports Medicine increased

maximum performance capacity over controls (International Journal of Sports

Medicine 8/92) Substance P and Prostaglandin E have been shown to be

increased in patients with unsuccessful acupuncture anesthesia (Pomeranz).

 

 

 

Attachments:

Acupuncture Coverage in Federal Health Care Benefits E2005 (PDF)

Acupuncture OPM Response EDated January 10, 2005 (PDF)

Acupuncture Memo to AAOM EDated January 11, 2005 (PDF)

 

 

 

Contacting Your Congressman

 

Letters, emails and calls to your representatives in Congress, urging them

to co-sponsor the Federal Acupuncture Coverage Act, are extremely effective.

If you don't know who represents you in Congress, you can find out by

entering your address in the " Write Your Rep " website sponsored by the House

of Representatives at www.house.gov/writerep.

 

Most Members of Congress can be e-mailed through their Web sites. You can

link to their sites through the main House of Representatives page at

www.house.gov.

 

A sample constituent letter follows. The addition of personal experiences,

as a patient or a practitioner, can be very helpful.

 

SAMPLE LETTER:

 

Dear Congressman/Congresswoman [name]:

 

As an acupuncture [provider/practitioner] in your district, I urge you to

cosponsor the Federal Acupuncture Coverage Act. The bill, sponsored by

Congressman Maurice Hinchey, would add an acupuncture benefit to Medicare

and the Federal Employees Health Benefits (FEHB) plan.

 

I am one of the millions of Americans who know how effective acupuncture can

be in treating chronic pain, addiction, and respiratory and digestive

ailments. Both publicly and privately sponsored research confirm its

benefits and the National Institutes of Health is continuing to study the

effective applications of acupuncture.

 

For patients in search of safe, holistic treatments with little or no side

effects, acupuncture has become an integral part of their health care

regime. It is a safe, effective and inexpensive alternative to Western

medicine. That's why more than 70 percent of the nation's insurers now cover

some acupuncture treatments.

 

Please support the Federal Acupuncture Coverage Act, which would give

federal employees, seniors and the disabled the freedom to choose

acupuncture.

 

Sincerely,

 

Name

Address

City State Zip

E-mail Address

 

 

 

 

 

Sincerely,

 

William Morris, OMD, MSEd, LAc

President, AAOM

 

# # # # #

 

Note: Should you no longer choose to receive AAOM Updates and News Alerts,

please notify us. Your name will be removed from our files, and we apologize

for the inconvenience.

 

AAOM

PO Box 162340

Sacramento, CA 95816

916-443-4770

916-443-4766 Fax

866-455-7999 Toll Free

info | www.aaom.org

 

 

 

 

 

 

 

[Guest guest]

too low as to scare off practitioners especially when the insureds want us

>>>>Well i guess you think the new $17.5 per half hour electroacupuncture is not

too low. I cant run my office for anything even close to this. I have had to

stop carrying several insurgencies as of 2005 because that's all the will pay me

and prohibit me form charging the patient for the noncovered amount.Many of

these blue shield blue cross programs have paid between $50-60 per visit until

2005, without this one to one patient contact.

On your other point, we have a lot of work ahead of us to document our cost

effectiveness, as we still need a lot of work documenting effectiveness. By

being less ietrogenic we are definitely less expensive even if questionably

effective.We do not kill or maim our patients.

 

 

 

 

[Guest guest]

Medicare coverage does not mean insurance coverage. Insurance companies

will most likely pay at or near similar rates. Passage will mean that more

will be forced to cover acupuncture. This could be the break we are looking

for.

Mike W. Bowser, L Ac

 

> " " <alonmarcus

>Chinese Medicine

><Chinese Medicine >, " docs list "

><docs-a-list >, " Acupuncture DiscussionList "

><acupuncturediscussionlist >

>Re: Fwd: [AACBoard-AnnounceList] Hinchey Bill

>Sat, 12 Feb 2005 09:37:59 -0600

>

>Passing the Medicare bill will result is all compensation for acupuncture

>becoming as low as our new codes. For those that have not experienced the

>new rates you will receive $17 per half hour of direct patient one to one

>care. If you what this to be the future of OM support the bill

>

>

>

[Guest guest]

Insurance companies do follow medicare as to whether or not to cover a

procedure but beyond that it is up to the insurance company to decide upon

amount. Remeber that it does a company no good to lower its reimbursement

too low as to scare off practitioners especially when the insureds want us.

Naive would be to think that we would be getting paid the same rate. It

could be worse or it could be better. That is what lobbyists are for. By

the way, healthcare spending in the US is at a rate several times that of

the military or in other words about 25% of the budgetary spending. Sad but

maybe politicians will start to realize how cost effective we are or not.

Later

Mike W. Bowser, L Ac

 

> " " <alonmarcus

>Chinese Medicine

><Chinese Medicine >

>Re: Fwd: [AACBoard-AnnounceList] Hinchey Bill

>Sat, 12 Feb 2005 11:07:44 -0600

>

>Medicare coverage does not mean insurance coverage. Insurance companies

>will most likely pay at or near similar rates. Passage will mean that more

>will be forced to cover acupuncture. This could be the break we are

>looking

>for.

> >>>Your statement is somewhat naive because as medicare goes so do other

>insu, although with the new codes it may not make any difference. Except

>that you may not charge a medicare patient above the covered amount (unless

>you will not join medicare) and which again would probably mean working for

>$35 per/hr.At least with privet insu you can say that you do not take insu

>and therefore charge what ever you want and just give a receipt to the

>patient. At the same time most newer practitioners would probably not get

>away with that as more and more patients will demand to be treated with

>insurance billing, especially medicare patients.

>

>

>

>

[Guest guest]

Are you saying you have received payments based on these new codes and $17.50

is what you were paid?

>>>>Yes i have.

 

 

 

 

[Guest guest]

Also - I do not really understand what Alon meant when he said he had to stop

carrying

>>>>>I dropped out of being in the PPO which used to at least cover between

50-60$

 

 

 

 

[Guest guest]

Do you really think so? By this logic, all WM insurance payments should

currently be the same rate as Medicare? Are they?

>>>>For western med they are very closs, sometimes even lower since some

companies tag their payments as a % of medicare rates

 

 

 

 

[Guest guest]

Hi Alon, - I have not yet received any insurance payments for 2005 so perhaps I

am in for the same unpleasant news you are stating here. Are you saying you have

received payments based on these new codes and $17.50 is what you were paid? Has

anyone else out there received such payments for the same codes? Any different

reimbursements? Also - I do not really understand what Alon meant when he said

he had to stop carrying

 

" several insurgencies as of 2005 because that's all the will pay me and prohibit

me form charging the patient for the noncovered amount. "

 

The only types of plans that prohibit one from charging for a non-covered amount

are Managed Care plans that pay providers of service a set amount agreed upon by

contract. Are you saying that you were under such Managed-Care contracts and

that they are now not paying you the fees agreed upon in your contract? Please

clarify - Matt Bauer

 

-

Chinese Medicine

Saturday, February 12, 2005 9:43 AM

Re: Fwd: [AACBoard-AnnounceList] Hinchey Bill

 

 

too low as to scare off practitioners especially when the insureds want us

>>>>Well i guess you think the new $17.5 per half hour electroacupuncture is

not too low. I cant run my office for anything even close to this. I have had to

stop carrying several insurgencies as of 2005 because that's all the will pay me

and prohibit me form charging the patient for the noncovered amount.Many of

these blue shield blue cross programs have paid between $50-60 per visit until

2005, without this one to one patient contact.

On your other point, we have a lot of work ahead of us to document our cost

effectiveness, as we still need a lot of work documenting effectiveness. By

being less ietrogenic we are definitely less expensive even if questionably

effective.We do not kill or maim our patients.

 

 

[Guest guest]

wrote:

> Passing the Medicare bill will result is all compensation for

> acupuncture becoming as low as our new codes. For those that have not

> experienced the new rates you will receive $17 per half hour of

> direct patient one to one care. If you what this to be the future of

> OM support the bill

>

 

Hi Dr. Alon!

 

Do you really think so? By this logic, all WM insurance payments should

currently be the same rate as Medicare? Are they?

 

Regards,

 

Pete

[Guest guest]

Thanks Alon - I hope your experience will not be typical for all insurance

companies but what you describe is certainly a bad sign. If other insurance

companies follow this trend, there will no doubt be a outcry for the heads of

those who took part in these changes. I would still like to hear from others who

have received payments for services rendered in 2005. Matt Bauer

-

Chinese Medicine

Saturday, February 12, 2005 11:57 AM

Re: Fwd: [AACBoard-AnnounceList] Hinchey Bill

 

Are you saying you have received payments based on these new codes and $17.50

is what you were paid?

>>>>Yes i have.

 

 

 

Also - I do not really understand what Alon meant when he said he had to stop

carrying

>>>>>I dropped out of being in the PPO which used to at least cover between

50-60$

 

 

[Guest guest]

When I go to WM they charge me a leg and an arm, I have to be there all

morning to see the Dr. for 15 minutes max and the place is just packed.

And, the WM guys all live in the best neighborhoods and send their kids

to private schools. I think if we get Medicare coverage we will get our

share of the traffic, if we want it. You don't *have* to take medicare.

>>>>>I think you have to separate those that have been in practice for a

while,and therefore have made their money, and those that are opening practices

now. While it is different in varying parts of the US, it is very difficult in

many areas such as in CA for new MD practices to make it. Many have closed their

practices or contracted with HMOs which now are looked at as good deals,

unbelievable. Many MDs have to work like dogs and make much less than you

think.My wife is a chief of OB at Kaiser and she gets hundreds of applications

from MDs trying to move into Kaiser because they are having a hard time making

it in privet practice.

 

 

 

 

[Guest guest]

was this was from Medicare

>>No, all blue cross blue shield in CA now pay per the new codes

 

 

 

 

[Guest guest]

wrote:

> Do you really think so? By this logic, all WM insurance payments should

> currently be the same rate as Medicare? Are they?

>

>>>>>For western med they are very closs, sometimes even lower since some

companies tag their payments as a % of medicare rates

 

Hi Alon!

 

When I go to WM they charge me a leg and an arm, I have to be there all

morning to see the Dr. for 15 minutes max and the place is just packed.

And, the WM guys all live in the best neighborhoods and send their kids

to private schools. I think if we get Medicare coverage we will get our

share of the traffic, if we want it. You don't *have* to take medicare.

 

Regards,

 

Pete

[Guest guest]

It sounds like they might be making a guess

>>>No. The new codes have a numeric value and there is a conversion scale. This

adds up to $17.5 for the 97813 and additional $17.5 for 97814 codes.To bill both

you should be seeing one patient per hour.

 

 

 

 

[Guest guest]

For an auto insurance claim I have received my fee of $60.00 per treatment

and I know of another who I work with who receives approximately her fee of

$69.50 from the HMO. I have not heard of anyone getting paid such a low

amount, was this was from Medicare?

Mike W. Bowser, L Ac

 

> " Matt Bauer " <acu.guy

>Chinese Medicine

><Chinese Medicine >

>Re: Fwd: [AACBoard-AnnounceList] Hinchey Bill

>Sat, 12 Feb 2005 14:36:08 -0800

>

>Thanks Alon - I hope your experience will not be typical for all insurance

>companies but what you describe is certainly a bad sign. If other insurance

>companies follow this trend, there will no doubt be a outcry for the heads

>of those who took part in these changes. I would still like to hear from

>others who have received payments for services rendered in 2005. Matt Bauer

> -

>

> Chinese Medicine

> Saturday, February 12, 2005 11:57 AM

> Re: Fwd: [AACBoard-AnnounceList] Hinchey Bill

>

> Are you saying you have received payments based on these new codes and

>$17.50 is what you were paid?

> >>>>Yes i have.

>

>

>

> Also - I do not really understand what Alon meant when he said he had to

>stop carrying

> >>>>>I dropped out of being in the PPO which used to at least cover

>between 50-60$

>

>

>

>

[Guest guest]

It sounds like they might be making a guess as to how it should be paid. I

have found that a HMO here did not understand that their own breakdown was

in error. We are working with them to try to get this cleared up. We need

to be clear about the billing and so do they. I would speak with a manager

as the typical people that answer the phones know little.

Mike W. Bowser, L Ac

 

> " " <alonmarcus

>Chinese Medicine

><Chinese Medicine >

>Re: Fwd: [AACBoard-AnnounceList] Hinchey Bill

>Sat, 12 Feb 2005 18:08:50 -0600

>

>was this was from Medicare

> >>No, all blue cross blue shield in CA now pay per the new codes

>

>

>

>

[Guest guest]

These are in 15 minute intervals, so how do you figure?

Mike W. Bowser, L Ac

 

> " " <alonmarcus

>Chinese Medicine

><Chinese Medicine >

>Re: Fwd: [AACBoard-AnnounceList] Hinchey Bill

>Sat, 12 Feb 2005 19:24:20 -0600

>

>It sounds like they might be making a guess

> >>>No. The new codes have a numeric value and there is a conversion scale.

>This adds up to $17.5 for the 97813 and additional $17.5 for 97814 codes.To

>bill both you should be seeing one patient per hour.

>

>

>

>

[Guest guest]

I have used the new codes and found that in WC, auto and health policies I

have received about the same or a few pennies more over the 5 cases returned so

far. It has involved some education of the carriers thus far, but they are

picking it up quick.

David Molony

 

 

In a message dated 2/12/05 3:28:09 PM, acu.guy writes:

>

> Hi Alon, - I have not yet received any insurance payments for 2005 so

> perhaps I am in for the same unpleasant news you are stating here. Are you

saying

> you have received payments based on these new codes and $17.50 is what you

> were paid? Has anyone else out there received such payments for the same

codes?

> Any different reimbursements? Also - I do not really understand what Alon

> meant when he said he had to stop carrying

>

> " several insurgencies as of 2005 because that's all the will pay me and

> prohibit me form charging the patient for the noncovered amount. "

>

> The only types of plans that prohibit one from charging for a non-covered

> amount are Managed Care plans that pay providers of service a set amount

agreed

> upon by contract. Are you saying that you were under such Managed-Care

> contracts and that they are now not paying you the fees agreed upon in your

> contract? Please clarify  - Matt Bauer

>

> -

>  

>   Chinese Medicine

>   Saturday, February 12, 2005 9:43 AM

>   Re: Fwd: [AACBoard-AnnounceList] Hinchey Bill

>

>

>   too low as to scare off practitioners especially when the insureds want us

>   >>>>Well i guess you think the new $17.5 per half hour electroacupuncture

> is not too low. I cant run my office for anything even close to this. I have

> had to stop carrying several insurgencies as of 2005 because that's all the

> will pay me and prohibit me form charging the patient for the noncovered

> amount.Many of these blue shield blue cross programs have paid between $50-60

per

> visit until 2005, without this one to one patient contact.

>   On your other point, we have a lot of work ahead of us to document our

> cost effectiveness, as we still need a lot of work documenting effectiveness.

By

> being less ietrogenic we are definitely less expensive even if questionably

> effective.We do not kill or maim our patients.

>

>  

>

>  

[Guest guest]

These are in 15 minute intervals, so how do you figure?

>>>>Your correct i was thinking about 30min instead of 15min.Still i cant run my

office on $70 per/hr

 

 

 

 

[Guest guest]

the new codes and found that in WC

>>>>You do not have a separate WC code in PA? David since the new codes have a

value attached to them i think you have been getting the same $ because many

insu companies are not up to date, just wait a little.Have you billed any of the

blues?

 

 

 

 

[Guest guest]

insurgencies

>>>David i never reread what i write so often my fingers run away with me.

 

 

 

 

[Guest guest]

At eight patients/day at $70.00 = $560.00 x 20 days/month = $11,200.00 x 12

= 6 figures income. Where are you at that you cannot make it on this

amount? I am shocked.

Mike W. Bowser, L Ac

 

> " " <alonmarcus

>Chinese Medicine

><Chinese Medicine >

>Re: Fwd: [AACBoard-AnnounceList] Hinchey Bill

>Sun, 13 Feb 2005 10:09:31 -0600

>

>These are in 15 minute intervals, so how do you figure?

> >>>>Your correct i was thinking about 30min instead of 15min.Still i cant

>run my office on $70 per/hr

>

>

>

>

[Guest guest]

mike Bowser wrote:

> At eight patients/day at $70.00 = $560.00 x 20 days/month =

> $11,200.00 x 12 = 6 figures income. Where are you at that you cannot

> make it on this amount? I am shocked. Mike W. Bowser, L Ac

 

Hi Mike!

 

One person can make it on 134K year, but what he is making is not all

profit. Don't know what his rent, utilities, supplies and insurance

cost. Don't know what he has to pay for help. Don't know how much

shopping his wife/girlfriend/whatever does . . .

 

Regards,

 

Pete