Acupuncture & Insurance: What You Need to Know
Insurance can help cover acupuncture, but figuring out what you’ll actually pay can be confusing. Here’s the short version.
First: Insurance Is Never a Guarantee
We can check your benefits and give you our best estimate, but nothing is guaranteed until your insurance company processes your claim.
Your final cost depends on your specific plan, the services provided, your diagnosis, and how your insurer processes the claim.
What Might You Pay?
Most acupuncture patients fall into one of these categories:
Copay: A set amount you pay per visit, such as $25 or $60.
Deductible: You pay the insurance-approved amount until you reach your deductible. After that, your plan may cover a percentage of the visit.
Coinsurance: You pay a percentage of the insurance-approved amount, such as 10% or 30%.
Out-of-pocket maximum: Once you reach your plan’s annual maximum, your insurance may pay 100% of covered care for the rest of the plan year.
Why Can the First Visit Cost More?
Your initial appointment includes a consultation and evaluation, which may be billed separately from acupuncture.
So even if your plan has a $25 acupuncture copay, your first visit could have an additional charge.
We won't know the final amount until your insurance processes the claim.
Deductibles Can Make Insurance More Expensive
If you have a high deductible, you may actually pay more through insurance than through our self-pay rates.
Our current out-of-pocket rates are:
$175 for the initial visit
$110 for follow-up visits
For example, your insurance might determine that an acupuncture visit has an allowed amount of $200 and apply that entire amount to your deductible. In that case, you could owe $200—even though our self-pay rate is $110.
If this happens, we can switch you to self-pay for future visits. However, once a claim has been submitted to insurance, we cannot retroactively bypass the insurance process.
Not Every Diagnosis Is Covered
Some insurance plans only cover acupuncture for specific conditions, often pain-related diagnoses such as back, neck, or joint pain.
Other concerns—such as digestive issues, fertility, skin conditions, anxiety, or other wellness concerns—may not be covered under your plan.
Some plans also limit the number of visits or require the insurer to determine that acupuncture is medically necessary.
Your provider will determine the appropriate diagnosis based on your clinical assessment. We never choose a diagnosis simply to obtain insurance coverage.
The Bottom Line
Before your first visit, we'll do our best to explain what your insurance benefits appear to be.
After your first claim is processed, we'll have a much better idea of what your visits are likely to cost.
But please remember: an insurance benefits check is not a guarantee of payment. Your insurance company makes the final decision when it processes your claim.
If you'd like to double-check your benefits yourself, call the Member Services number on the back of your insurance card and ask about acupuncture coverage, your deductible, copay/coinsurance, visit limits, and covered diagnoses.
Insurance is complicated. We’ll do our best to make it a little easier to understand.