American Specialty Health

Kaiser, HealthNet, Anthem Blue Cross, Cigna, and Aetna

If your insurance covers acupuncture services through American Specialty Health(ASH) the following pertains to you. 

We are an In Network provider with American Specialty Health and will submit your health claims directly to ASH.  You are responsible for paying your co payment amount at the time of your appointment. The remaining amount will be paid by your insurance when you have coverage and acupuncture benefits

Our office is able to check your insurance benefits but ultimately, it is your responsibility to contact your insurance plan and understand your coverage and benefits.  

Your insurance plan may require a referral from your primary doctor or pain management.  It is your responsibility to obtain a referral, when required, in order for your insurance to cover your acupuncture treatment.  Referrals have expiration dates and it is your responsibility to know when your referral expires.  Once a referral expires all claims will be denied and returned unpaid.  You, the patient, will be responsible for any unpaid acupuncture treatments due to a missing or expired referral. 

Your insurance plan requires the pre approval of acupuncture treatments through a Medical Necessity Review Form (MNR).  The MNR process is required even if your plan states it has unlimited or X amount of yearly treatments.  The first set of treatments may be used by the patient without medical necessity review, subsequent visits will require an MNR and approval by ASH.  Please be advised that due to this requirement the coordination and availability of your benefits and coverage may be impacted. Our office will do everything we can to submit the necessary documents and information to ASH in order to get approval of additional treatments, however ultimately the insurance company has the contractual right to deny additional treatments at their discretion.  

ASH only covers CPT code 97810.  That means that your coverage is ONLY for acupuncture treatments of 15 minutes.  ASH doesn’t cover a full acupuncture treatment but in our office we do not discriminate based on your insurance and will gladly provide a full 1 hour treatment to all patients regardless of their particular insurance. 

Covered conditions: physical pain only

Non-covered services include the following: cupping therapy, gua sha, massage, nutritional consultations, herbal supplements and herbal consultations. If these services are indicated to treat your condition, the recommendation will be made for you at the time of service and you will be notified of the additional costs.