Premera & Acupuncture

Coverage Overview

Premera Blue Cross is a Blue Cross plan based in Washington and Alaska, so most Premera patients we see in Los Angeles are here for work, study or family rather than because their plan is a California one. Care away from your home plan area runs through the BlueCard programme, which is the mechanism that lets one Blue plan's members be treated by another Blue plan's providers. Nature Acupuncture & Herbs accepts Premera at our Los Angeles clinics.

Under BlueCard your benefits stay with your home Premera plan while the local Blue plan handles the provider side, and the practical consequence is that the answer about your acupuncture benefit still comes from Premera rather than from anyone in California. We verify against your member ID before your first visit, and it is worth allowing a little more time for an out-of-area verification than a local one.

What's Typically Covered

• ◈Accepted at all three Los Angeles clinics
• ◈Out-of-area members seen through the BlueCard programme
• ◈Benefits verified with your home Premera plan
• ◈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 Premera 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?”