TriWest & Acupuncture

Coverage Overview

TriWest Healthcare Alliance administers the VA Community Care Network across the western United States, which is how a veteran gets care from a community provider rather than at a VA facility. Acupuncture is part of that, and the route into it is different from commercial insurance in one important way: it starts with a referral from the VA rather than with a call to a benefits line. Nature Acupuncture & Herbs sees TriWest patients at our Los Angeles clinics.

The sequence matters. Your VA provider assesses eligibility and issues a referral, the authorisation comes through TriWest, and care is then delivered by the community provider under that authorisation. Treatment is documented against pain levels and functional improvement, which is more structured than most commercial plans require. Because the authorisation defines what is approved, we check its scope before starting rather than partway through a course of care.

What's Typically Covered

• ◈Seen at all three Los Angeles clinics
• ◈Care delivered under your VA authorisation
• ◈We check the scope of the authorisation before starting
• ◈Progress documented against pain and function, as the programme requires
• ◈Referral comes from your VA provider, not from us
• ◈We will tell you if a new authorisation is needed before you run out

How to Check Your Own TriWest 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?”