Alignment Health Plan & Acupuncture

Coverage Overview

Alignment Health Plan is a Medicare Advantage carrier operating in Southern California, which makes its acupuncture benefit easier to reason about than a typical employer plan: Medicare sets a floor that every Medicare Advantage plan has to meet, and the plan may choose to offer more on top. Nature Acupuncture & Herbs accepts Alignment at our Los Angeles clinics.

The Medicare floor is narrow and specific, and it is worth knowing before you call, because it explains answers that otherwise sound arbitrary. Medicare covers acupuncture for chronic low back pain only, with defined visit limits and a requirement that treatment stop if you are not improving. Many Medicare Advantage plans add a supplemental acupuncture benefit that goes beyond that, which is the thing worth asking about specifically.

What's Typically Covered

• ◈Accepted at all three Los Angeles clinics
• ◈Medicare floor applies for chronic low back pain
• ◈Supplemental acupuncture benefits checked, where the plan offers them
• ◈Billed with standard acupuncture CPT codes
• ◈We verify your plan before your first visit
• ◈We tell you what is covered before you are treated, not after

How to Check Your Own Alignment Health Plan 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?”