Is Acupuncture Covered by Health Insurance? (Yes, In California!)

Is Acupuncture Covered by Health Insurance? (Yes, In California!)

Understanding how insurance works with acupuncture can save you thousands of dollars. Here’s a step-by-step guide to deciphering insurance language.

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Reviewed by Den Bremond, DACM, RN L.Ac.
Owner and founder of The Acupuncture Den in San Francisco

Did you know your California health insurance plan has acupuncture benefits? It’s the law - 100% of plans in California are required to have coverage for acupuncture.* Finding an in-network provider can mean the difference of paying $25 / session instead of $150 / session. With just a few sessions, that can save you $1000+.

At Rupa Health, we’re able to save patients thousands of dollars by finding them care covered by their insurance plan.

Determining insurance coverage for acupuncture can be tricky, though. Only 50% of acupuncturists in the Bay Area list insurance information on their websites, and even when they do, the language can be vague and confusing. Here’s how to navigate insurance when it comes to acupuncture.  

What does “in-network” mean for an acupuncturist?

This is what you’re looking for - the gold standard. This means the practitioner has a contract directly with the insurance company. The practitioner is required to send bills directly to your insurance company and your benefits will automatically be applied. They get paid rates determined by the insurance company.

How much do I pay when an acupuncturist is “in-network”?

You will pay a copay or coinsurance depending on your insurance plan design. How much you pay will also be determined by your deductible. Even before you start your search for an acupuncturist, we highly recommend calling your insurance company to find out your exact benefits. By understanding your plan, we’re able to match many of our patients with great in-network providers and get them sessions at $25 / session or less.

What does “contracted” or being a “preferred provider” mean?

Source:    Enliven Health

Being “contracted” or being a “preferred provider” is the same as “in-network”.

What does it mean when an acupuncturist “accepts” insurance?

This is tricky - it depends! Generally it means one of two things:

  1. They are in-network will the insurance companies listed and are just using “accepts” casually.

  2. They are out of network, but willing to bill your insurance.

When you see “accepts”, call or email the office and ask if they are in-network and contracted with your insurance plan or if they are out of network.

How much do I pay when an acupuncturist is “out of network”, but “accepts insurance” or can “submit claims” for me?

This is the trickiest. You pay the full cash (out of network) price, minus how much ever your insurance will reimburse for an out of network practitioner. This happens in two main ways:

  1. You pay upfront for the full cash (out of network) pricing. Then the office will submit a bill to your insurance, and you will directly receive a reimbursement for how much ever your insurance will cover.

  2. The practitioner’s office will submit a bill to insurance, they will get paid by the insurance company, and you will be billed for the remainder.  

The actual amount your insurance will cover is tricky to figure out ahead of time, and if someone is “out of network” but accepts insurance, you should be willing and prepared to pay the full cash price.  

What does it mean when an acupuncturist will “bill insurance” for me?

Source: Jennifer Carino Acupuncture

Source: Jennifer Carino Acupuncture

The office will submit claims  on your behalf even if they are out of network. If they didn’t do this, you’d have to print out a form and submit your own claim to receive any benefits.

When they are in-network, they will bill for you. Chances are high that when they say they “accept” insurance, they will bill for you.

What does it mean when a website says they can provide a “superbill”?

The  practitioner is out of network with your plan and will not bill on your behalf. Generally, they will print out a superbill for you, and you’ll mail this form in to your insurance in order to receive any reimbursement. (How you submit your superbill depends on your insurance company - call them!)

What is a superbill?

This is basically a fancy medical receipt. It includes all the medical billing codes needed to process your out of network claims.

Note that when you submit a Superbill, you won’t actually get money reimbursed by your insurance company unless you’ve hit your deductible.

Can I use my FSA or HSA to pay for acupuncture?

Yes, in California! Most FSAs and HSAs consider services with acupuncturists “eligible expenses”. Double check with your health funds administrator before swiping your card, but it’s most likely eligible. If your practitioner can’t accept your FSA or HSA card, grab a superbill and a receipt to submit for reimbursement with your FSA administrator.

How do I find an acupuncturist who is in network with my insurance?

We’re here to help! Over 80% of our practitioners are in network with at least one insurance provider. We also match you based on location, specialty, personality, and more. We don’t stop until you are happy with your practitioner, guaranteed. Message us at Rupa Health to get started.

*Disclaimer: This post is specifically for California Insurance plans, but is a good overview for anyone trying to navigate their insurance benefits for holistic care.  In California, acupuncture is considered an “essential benefit”, meaning every insurance plan is legally required to have some sort of acupuncture benefit. However, the details are tricky and there are all sorts of restrictions on coverage and reimbursement you need to be aware of. We can help!

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