Let's Talk Insurance: Key Vocabulary Terms to Understand your Benefits

An insurance policy is a contract between you and your insurer, and includes a lot of minutia that can be difficult to decipher. The details of what is and isn't covered, and under what specific circumstances, can seem boring until you actually need to use your insurance, at which point it can quickly become frustrating and unpredictable.

So, what should you know if you're looking to use your insurance benefits for acupuncture? When it comes to using your insurance, understanding the details is a lot easier when you understand the language most commonly used to describe your coverage.

Here are some key terms and their definitions, to help guide your conversation with your insurance company.

1.In Network/Out of Network Acupuncture Coverage: Start Here!

Providers who are contracted with an insurance company are called "in network providers." This means they have agreed to work with the insurance company on the cost of services, which usually means savings are passed on to you. Some plans also offer out of network benefits. Seeing an out of network provider may be somewhat more expensive than an in-network provider, but if you have this coverage it will give you more provider options. At this point in time, acupuncture is not a standard benefit on each and every insurance plan, so a call to your insurance company is a good starting point. The first question we recommend asking is, "Do I have in-network and/or out-of-network acupuncture benefits on my plan?"

If you have in-network coverage only, you will need to find a provider who is contracted with you plan. At Sparkes Acupuncture, we are in-network with our local Blue Cross Blue Shield. While we accept multiple other insurance plans, we participate as an out-of-network provider.

If you do not have coverage, we offer a TOS (Time of Service) discount that can be applied only when paying for services on the same day as they are performed. This discount cannot be combined with insurance billing, though a superbill is available upon request. Call our office for more information about our TOS discount for people who are not using insurance.

2. Deductible: Out of Pocket Cost Requirements

3. Copay/Coinsurance: Whats the difference?

4. Provider Type: Who Performs the Health Services

5. Diagnosis Restrictions: What Can be Treated with Acupuncture

6. Visit Limit: How Many Sessions are Allowed

When you call your insurance company, remember to take notes and always take down a reference number at the end of the call. We are happy to do what we can to help you understand your coverage, and routinely call insurance companies to ask the questions outlined above.

We hope that understanding the above terms help to empower you to enact a care plan that you understand, and is in line with your budget & wellness goals!

Disclaimer: the above information is for informational purposes only, and we hope it serves you as a starting point to understand insurance in general. Insurance has a lot of nuance, so we do not assume any responsibility or liability for errors or omissions in this blog post. Your insurance coverage is a contract between you and your insurer, and we do not claim to understand the details of your policy in this post. Your use of the above described method of understanding insurance and calling to verify your benefits is at your own risk and responsibility. Some of this information may not apply to you, or may be different than described. The author's views are her own.

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