Optum & Acupuncture

Coverage Overview

Optum sits in a different place in the system from a carrier like Aetna. It is part of UnitedHealth Group, and for acupuncture it usually appears as the network or benefit manager standing behind someone else's plan rather than as the insurer on your card. Patients often arrive unsure whether they have "Optum insurance" at all. Nature Acupuncture & Herbs accepts Optum at our Los Angeles clinics.

What matters for an Optum patient is which plan Optum is administering the benefit for, because that plan sets the visit limits and the copay. The Optum side typically governs network participation, authorization and how care is documented. We work out which is which when we verify your benefits, so you are not left translating between two organisations on the phone.

What's Typically Covered

• ◈Accepted at all three Los Angeles clinics
• ◈We identify which plan sits behind your Optum benefit
• ◈Authorization requirements checked before your first visit
• ◈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

How to Check Your Own Optum 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?”