Coverage for Acupuncture
Health Insurance
Health insurance plans come in many forms. Our goal at Caruso Acupuncture is to help you utilize your insurance coverage for your treatments. The following information should help to eliminate confusion, surprises and assumptions regarding which services may or may not be covered under your plan.
In-Network & Out-of-Network Providers
Please note, Frank Caruso, L.Ac. is in network with Anthem BCBS, Federal BCBS, UnitedHealthcare, Optum, and the VA. For Medicare, at this time, we only bill United Healthcare Plan C. Frank Caruso, L.Ac. CANNOT bill Medicare Plans A or B, even if your “secondary insurance covers it.” Congress is working on it. Also, AARP is NOT a Plan C. As of now, we do not bill Medical Mutual, Medicaid or Worker’s Comp. To our knowledge no Medical Mutual plans cover acupuncture. If we are out of network, ask if you have “Out of Network Benefits,” in which case we can submit a claim.
To determine whether or not your plan covers acupuncture services, please assist us by answering the questions below by contacting your insurer ahead of time for the specifics. It’ll also be important to know if you have a deductible and has it been met, and if there is a copay.
Any information we can gather prior to rendering services will be helpful.
How Payment Works
If your plan covers acupuncture, we will file a claim on your behalf. Yet until payment is established with your insurer, payment via cash, check or credit card will be due at the time of your first treatment. Payment may also be due on follow ups if we have not heard back from your insurance company.
Once your insurance company begins paying for treatments, you will no longer need to pay unless there is a copay, or if the deductible has not been met. Any positive balance you have will be reimbursed to you or credited for future copays, whichever you prefer.
Please answer the questions below to verify coverage.
Provide this information to the insurance rep on in your online protal:
Provider: Francis (Frank) Caruso, L.Ac.
NPI: 1992977227
Practice: Practicing at Caruso Acupuncture
Your Information:
Your Name: ————
Date of Birth: ————
Insurance Company: ————
Member ID: ————
POLICY BENEFITS
Is Frank Caruso in your network?
If not, do you have “Out of Network” benefits?
Is Acupuncture covered?
Specifically ask about procedure codes 97810 and 97811.
Is there a deductible and will it be met by the time you come to see us?
Is there a co-pay?
How many treatments are allowed per year?
Diagnosis limitations? What disorders are and are not covered?
For example, back pain M54.59, neck pain, M54.2, headache, N51. The representative on the phone may need a diagnosis code (called an ICD-10) not just a description of where you have pain. Your plan may cover neck and back pain, or infertility, but plantar fasciitis, for example.
Have Questions?
If you have any questions about insurance coverage or billing, please contact us directly.