There are 3 kinds of insurance patients who do not have to pay for treatment at time of service. However, before we treat them, we have to make sure they are qualified to use their insurance.

 1. Health Partners: Includes patients who have a referral from their primary care clinic; who can self-refer for acupuncture; or who have Open Access plans. These must all be verified through HP Member Services before the patient receives treatment.

2. Car Insurance: The car insurance company must authorize treatment. Frequently, insurance companies say they will not pre-authorize, but they will say that the claim is "open." The claim must be open, and there must be enough money left in the claim to reasonably cover treatments. When there is doubt, ask the patient to pay for the treatment: we will reimburse them after we are paid by the insurance company. If the patient wants us to bill their lawyer instead of directly to the insurance company, make sure that they pay for the visit.

3. Workers' Compensation: These cases must be authorized by two sources: by the patient's case worker (often called a QRC), and also by the Workers' Comp. Administration company. Please ask for this information at the time the first appointment is made. You wil1 need the patient's claim number and/or I.D. number, as well as the name and phone number of the case worker and Workers' Comp. contact person. If a person has already come for their first visit before we have had a chance to verify their status, they must pay.

 

There are 2 kinds of insurance that TCM bills directly, but the patient must pay for the treatment at time of service.

1. Patient Choice/Choice Plus: patients are required to pay in full for acupuncture and consultation at the time of service, due to difficulties  we've experienced with Patient Choice. Herbs cannot be billed to insurance, and must also be paid for at time of service. Benefits must be verified through the Patient Choice help line (see below). If the employer is the University of Minnesota, patients need a doctor's referral and medical review, and must pay for treatments, even if authorized.

2. U Care: Infrequent. See the following.

 There are a few kinds of insurance that TCM bills directly as a courtesy to the patient, but the patient must pay full price at time of service.

1. United Health Care 

The following types of insurance never reimburse TCM for acupuncture. Patients must pay full price out-of-pocket at time of service. If the patient requests it, TCM will provide these patients with an Expense Report with treatment dates and payment.

1. Blue Cross/Blue Shield

2. Medica

3. Medicare/Medicaid (unless it is also a HealthPartners patient)

4. Aetna, Definity Preferred One, etc. 

When you book any new patient, always mention how much it costs. If they say they intend to use their insurance or Workers' Comp. to pay, find out right then what insurance they have. If it is one that TCM bills directly, get the information we need. 

If it is any other insurance, make sure they understand they will have to pay for their treatments at the time of service. Any questions they have about insurance coverage will have to be referred to their own insurance company. (You can also refer them to Leila at the TCM-Edina clinic 952 926-4011.) TCM is always willing to give any patient an itemized record of their treatment with us (an Expense Report), which they can then present to their insurance company. United Healthcare claims must be submitted on a computer- generated HCFA.

It is always better to check insurance status beforehand, when the appointment is initially made, than to wait until the patient presents for treatment. 

For Health Partners patients:

    Verify the authorization with Member Services (952) 883-5000. Be sure to ask the following four questions: Is acupuncture a covered benefit? Can the patient self-refer for treatment, or does (s)he need a clinic to refer? Does the patient have a deductible? What is the co-pay amount?

    Collect the co-pay at the time of each visit.

    (For Grand Ave. and AAAOM clinics only: enter visit and co-pay into quickbooks.)

For Patient Choice patients:

    Collect the full payment for treatment at the time of each visit. TCM will reimburse the patient after Patient Choice has paid us.

    Verify patient benefits through Wausau Benefits Helpline 1-877-233-1800. This is an automated line, and you will need the following infonnation to get a response: patient's I.D.#, TCM's-tax I.D.#, and a fax line that Wausau can respond to.

     Enter the visit and payment on the patient's sheet in the insurance logbook. (Grand Ave. and AAAOM also enter in quickbooks.) 

Car Insurance and Worker's Compensation:

    With these two types of insurance, patient care notes written by the acupuncturist must be submitted with the claim. The more "professional" these notes are, the better. It is extremely important that the entry for each visit specifically states that the patient had "acupuncture", "heat lamp"/"TDP", "elecro-stimulation" or "massage" (if administered). 

U Care:

    We have had a very difficult time collecting claims from U Care because we are not an authorized provider. We would prefer to keep the numbers of these patients limited. It is imperative to obtain a copy of the referra1/authorization from the referring clinic, and to make sure that the authorization is extremely   dfic as to exact dates of service, and also as to exactly what is being authorized (e.g. "consultation. acupuncture, heat lamp").