UMR & Acupuncture

Coverage Overview

UMR is a third party administrator owned by UnitedHealthcare. That distinction matters more than it sounds: in most cases UMR is not the insurer. Your employer funds the plan and writes the benefits, and UMR processes the claims. It is why a UMR card can look like a UnitedHealthcare card while the acupuncture benefit behind it is completely different. Nature Acupuncture & Herbs accepts UMR at our Los Angeles clinics.

Because UMR administers self-funded plans, there is no single UMR acupuncture policy to look up, and any site that quotes you a UMR visit limit is guessing. The benefit is whatever your employer chose. What is consistent is the claims plumbing, which follows UnitedHealthcare practice, so the acupuncture CPT codes and the way a visit is billed are predictable even when the coverage is not. We verify your specific plan against your member ID before your first visit.

What's Typically Covered

• ◈Accepted at all three Los Angeles clinics
• ◈We verify your employer plan before your first visit
• ◈Claims processed on UnitedHealthcare systems
• ◈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 UMR 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 UMR 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?”