Anthem Blue Cross & Acupuncture

Coverage Overview

Anthem Blue Cross is one of the two large Blue plans in California, and it is not the same company as Blue Shield of California despite the similar name and the similar card. If you are not sure which one you have, look at the logo on your card rather than the word "Blue". Nature Acupuncture & Herbs accepts Anthem Blue Cross at our West LA, Hawthorne and Lynwood clinics.

Anthem sells employer group plans, individual plans bought through Covered California, Medicare Advantage plans and Medi-Cal managed care plans in California, and acupuncture is handled differently across those families. On employer plans the benefit is usually a choice the employer made, so two Anthem members can have genuinely different answers. On a Medicare Advantage plan the floor is the Medicare rule for chronic low back pain. We verify which family your plan sits in before your first visit.

What's Typically Covered

• ◈Accepted at all three Los Angeles clinics
• ◈We verify your specific plan before your first visit
• ◈Employer, individual, Medicare Advantage and Medi-Cal managed care plans all handled
• ◈Billed with standard acupuncture CPT codes
• ◈FSA and HSA cards accepted if acupuncture is not covered
• ◈We tell you what is covered before you are treated, not after

It Depends Which Anthem Blue Cross Plan You Have

These plan families handle acupuncture differently, which is usually why two people with the same card get different answers.

How to Check Your Own Anthem Blue Cross Benefit

Plan documents are written for the plan, not for you. Two people with the same carrier on their card can have completely different acupuncture benefits, because the employer chooses the design. Anything below describes what the carrier publishes; only a call against your own member ID tells you what you have.

Before you call

• ◈Your member ID and group number, both on the front of your card
• ◈The member services phone number from the back of your card
• ◈Your date of birth and the subscriber name, if the plan is not in your name
• ◈A rough description of what you want treated, and how long you have had it

What to ask, word for word

1. 1.“Is acupuncture a covered benefit on my plan, and does it need prior authorization or a referral?”
2. 2.“Are CPT codes 97810, 97811, 97813 and 97814 covered, and how many units per visit?”
3. 3.“How many acupuncture visits am I allowed per year, and how many have I used?”
4. 4.“What is my copay or coinsurance for acupuncture, and does my deductible apply first?”
5. 5.“Is a licensed acupuncturist (L.Ac.) an eligible provider type, or must it be an MD or DC?”
6. 6.“Does coverage depend on the diagnosis, and which conditions are eligible?”