In case you hadn't heard the news, Regence Blue Cross Blue Shield is recommending pre-authorization for Acupuncture services for all members starting November 1, 2013 in Oregon, Washington, Idaho and Utah.  Starting February 1st, 2014 this will be a requirement, not just a recommendation.

The full details of this change can be found HERE on the Regence Oregon website.

It looks like the process will be pretty easy and handled by an organization called CoreCare National, LLC.  You will have to register your credentials with them and can either call or go online to obtain a pre-authorization for the specific diagnosis code and CPT codes you want to bill for.

A complete list of all the CPT codes required to get pre-authorization for is on the Regence site linked above, or HERE if you want to go direct.

Its been clear for the past year that Regecen has really been buttoning down on Acupuncture.  Regence used to have some of the best reimbursement rates in my practice and now it is one of the lower eschelon to be sure.  This move does not have me hopeful of a strong reimbursement rate in the future as the Affordable Care Act gets into full swing, but we'll just have to take it step by step and see what happens in the coming years.

For now, if you are a preferred provider with Regence in Oregon, Washington, Idaho or Utah its time to get signed up with CCN and start familiarizing yourself with the pre-authorization process.  Regence is offering several webinars about it this month.  They are free and you can sign up through the Regence page linked above.

Good luck all you Acu-Stars out there, lets keep fighting the good fight!
~Rebecca Hurwood, LAc

Its here!  The Affordable Care Act has gone into effect despite all the brouhaha in DC and the traffic on the exchange websites is high enough to cause glitches here and there is a good sign I think.

In Washington State, a minimum of 12 Acupuncture treatments per plan year is included in the essential benefits list, so ALL Washington State plans will include Acupuncture coverage starting in 2014.  How cool is that?

While I don't have time to review the plans online in every state, I did take the liberty of scanning all the Individual and Family plans in Oregon and compiled the best list I could of which plans include Acupuncture coverage:

• Bridge Span Health Plans - no Acupuncture coverage under any individual plans
• Family Health Care - Medicare and Medicaid Oregon Health Plans only. NOTE that Medicare does not cover Acupuncture at this time.  The OHP Plus plan does include Acupuncture services though the exact benefit is not listed on the OHP site.
• Health Republic Insurance Company - NEW!  Health Care Co-Op option.  All plans cover 40 combined Acupuncture + Chiropractic Visits
• Health Net - does not currently list acupuncture benefits in any of their individual & family plans but it looks like a glitch - they have traditionally covered Acupuncture and Chiropractic under all plans.  I talked to Provider Relations and they indicated Health Net was not dropping Acupuncture coverage but couldn't give me specific plan details.  They referred me to their Affordable Care Act information line but I have been unable to get through.  Group health insurance will most likely continue to cover acupuncture.  Confirm  benefits with a sales person if you are considering these plans.
• Kaiser Permanente - Plan details are not listed online at this time.  Traditionally all Kaiser patients (aside from Medicare only coverage through Kaiser) have access to Acupuncture through referral whether they have a "self refer" benefit or not.  Expect this benefit to continue, but speak to a sales representative to confirm if considering a KP plan.
• Lifewise - Acupuncture included in the Gold and Broze VA plans
• MODA Health - Acupuncture included in the Gold-Be Protected, Silver - Be Prepared and Silver - Be Smart plans.
• Oregon's Health Co-Op - another NEW health care co-op insurance agency!  Acupuncture included in SiMPLE Silver, Bronze and Gold plans as well as all Group plans
• PacificSource - Acupuncture included in the Balance Bronze 6350, Silver 2500 & Silver 1500 plans
• Providence - no Acupuncture coverage evident in any of the Individual & Family plans.
• Regence Blue Cross Blue Shield - Acupuncture is not currently listed as a covered OR an excluded benefit in their individual plan brochure so I cannot confirm or deny coverage, but traditionally BCBS has been good at providing alternative care benefits to members.
• Trilium - like Family Health Care, provides Medicare/Medicaid/OHP plans only.  As with Family Health, Medicare does not cover Acupuncture but the OHP plan does though again - the exact benefit isn't listed.

Since Group plans are subject to employer approval I did not review all of them, and I highly recommend working with a broker to compare plans and determine which one is right for your business if you are selecting something new or considering doing so.  The health care exchanges generally have qualified brokers who can help you review and compare group and individual plans - you can get referrals to them through your state's health exchange website.

If you are self-employed there may be some new benefits available to you as well.  Check out THIS PAGE on the Healthcare.gov site for an FAQ.  It isn't comprehensive in any way, it really just directs you to go to your state exchange, but it is still nice that the government addressed and highlighted this issue.

Lastly, I wrote a patient-centered blog post about this on my clinic website today and if you need a place to start for your patients to answer questions about ACA and Acupuncture, feel free to point them there or lift information and post it on your site or ezine.  All I ask is that if you reproduce something from my blog you link back to me as the source of information.

Enjoy Fall, everyone, and lets hope the government gets its act together and starts functioning again soon.  Hey, any LAc's in DC?  Can you go do some group treatments for Congress?

Until next time,
~Rebecca