Does Health Insurance Cover Acupuncture? (in USA)

By Samantha on March 25, 2011

The long and short answers are: some do, and some do not. There is no simple answer to this question that covers all private health insurance carriers. In fact, many carriers have found a way to straddle the fence on the matter by offering affinity programs, or discount programs, to assess the risks and rewards of offering acupuncture benefits.

Why do Some Insurance Companies Not Cover Acupuncture?

Acupuncture has been practiced in China for thousand of years, but was widely unknown to the Western world until the 1970’s. At the time, it was considered by Western doctors as an anecdotal treatment, with no real medical value. The basis of acupuncture treatment is to balance energy, or qi (pronounced “chee”), flow along pathways (meridians) in the body. Qi is balanced by strategically placing needles along the meridians that correspond with the body’s organs. This balancing act promotes wellness and healing, but could not be proven definitively by Western science.

Why the Change of Heart?

How and why acupuncture works is widely unknown, but its benefits are supported by science. In 1997, the National Institutes of Health formally recognized acupuncture as a mainstream medical treatment that is safe, and effective, with no side-effects. Growing demand for acupuncture therapy, coupled with scientific research, prompted some insurers to waste no time in offering customers coverage for the alternative therapy. Some insurers in California, Arizona, and Michigan offered their customers the following:

  • In Arizona, CIGNA tested a program offering members access to: a network of 500 acupuncturists; other alternative health therapies; discounts on homeopathic remedies; sports nutrition products; books, and videos. No referral from a primary care physician was needed. The program was so successful it was instituted nationally the following year.
  • Blue Cross Blue Shield Service Benefit Plan of California offers their customers an affinity program giving them access to a national network of acupuncturists. The benefit was administered through American Specialty Health Networks. Members get a 25% discount on office visits to any ASHN practitioner, and no referral is necessary.
  • In Michigan: Blue Care Network, Care Choices of Michigan, and Health Alliance Plan have programs that offer discounts on acupuncture, and other alternative therapies, without a physician’s referral.

Does My Insurance Cover Acupuncture?

That depends on a number of factors such as:

  • Insurance carrier
  • State policy purchased in
  • Plan type (PPO, POS, HMO)
  • Medical necessity of treatment
  • Condition being treated
  • Use for pain management or alternative therapy
  • Number of treatments
  • If acupuncturist is a medical doctor

With something like car insurance it is fairly easy to understand what is standard coverage and what is not, while with health insurance and acupuncture it may take a little digging on your part. You can learn if your insurance carrier has an acupuncture benefit by speaking to a members’ service representative, or speaking to your human resources department. The insurance carrier’s website may also provide information on their acupuncture benefit, or lack of. Aetna is one carrier that makes it very easy for customers to understand their stance on acupuncture treatment. Aetna covers acupuncture for conditions with adequate scientific proof of its benefits. Their website lists the treatments they cover acupuncture for, like:

  • Chronic low back pain
  • Migraine headache
  • Nausea of pregnancy

Other conditions such as:

  • AIDS
  • Carpal Tunnel Syndrome
  • Peripheral Artery Disease

The above are not covered because of a lack of scientific proof of efficacy compared with placebo, or other modalities.

What if My Insurance does not Cover Acupuncture?

If your insurance does not cover acupuncture then speak out. Customer demand plays a role in swaying a health insurer towards certain offerings. Let your insurer know that the demand for acupuncture therapy exists. The reason many insurers decided to cover acupuncture therapy was to keep current customers happy, and broaden their appeal to potential customers. Discount and affinity programs are how insurance companies are testing the benefits of providing acupuncture therapy. Many acupuncturists believe eventually these programs will grow into full insurance coverage of their services.

What are My Options if Acupuncture is not Covered?

There are lots of options if you want to try acupuncture, but your health insurance does not offer the benefit. Some of the easiest options are:

  • Shop around for therapist that offers the best price. Often, they give first time visitors a discount.
  • Hospitals and doctors’ offices may have lists of acupuncturists. They may have information from patients’ experiences with certain acupuncturists, or their own experiences, you may find useful. Healthcare centers are more involved than ever making sure patients have access to alternative therapies. For example, Dana-Farber Cancer Institute located in Boston, built the Zakim Center for Integrated Therapies. The Zakim Center offers acupuncture, massage therapy, nutritional guidance, and other services for Dana-Farber patients at deeply discounted rates.
  • Switch insurance carriers. This is definitely the most difficult of choices. If acupuncture therapy benefits are important to you as a consumer, you have the right to find an insurer that meets your needs.

Since 2000, the number of private health insurers covering acupuncture therapy continues to rise. Legislation to require all insurance carriers to have an acupuncture benefit includes Medicare. As acupuncture continues to integrate into the American mainstream, everyone will have it as a treatment option. Author Bio: Samantha is a health and personal finance writer that is an expert on both healthy living tips and insurance savings ideas. She contributes for a website with insurance company reviews as well as a website to save money on car insurance. When she is not writing she can usually be found with her family at the beach for the weekend.

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