Should an Acupuncturist Accept Insurance?

The question of accepting insurance is a big question for an acupuncturist. There are lots of pros and cons:

Pros

More patients are able to afford your services. This leads to having more patients. Insurance allows patients who couldn’t afford full rates to be able to get the healing they need. This is a helping profession and most acupuncturists enjoy helping others: more patients means more helping.
There are lots of marketing benefits to accepting insurance. First, an acupuncturist doesn’t need to say no or dodge the question when asked if they accept insurance. Second, if you are an in-network provider for a company, your name will be published in their directory, which can drive patients to your practice. Though this can sometimes take up to a year as they publish directories annually. Currently, most new providers are almost immediately available on the internet.
A more lucrative practice. While some insurance companies pay less than most acupuncturists charge, others pay more. Workers’ compensation, at least in California, pays very well. And, generally, more patients, even at less pay, means more money to the bottom line. The authors have never heard of relatively new, very successful practices, outside of elective practices such as reproductive medicine or facial rejuvenation, that do not accept insurance. We are sure they are out there (so please don’t write letters), it is just easier to be really successful by accepting insurance.
A more diverse practice. Having a mixture of patients including cash patients, insurance patients, workers’ compensation patients, personal injury patients, and discount patients, means more diversity. More diversity means more ability to withstand shakeups in the regulatory environment or the economy. An example of this is when California, overnight, stopped paying workers’ comp. We know many acupuncturists that went from having very, very lucrative practices to bankruptcy in six months. By the same token, when the economy goes into a recession, many cash patients will not be able to afford acupuncture. But insurance patients can keep coming without much change to their pocket book.
Successfully taking insurance forces efficiencies. If one is not organized, it is difficult to take insurance and get paid on a regular basis. Accepting insurance means treating your patients more effectively, both clinically and non-clinically.

Cons

More paperwork. Potentially a lot more. Most of it, such as outcome assessments, should be done anyway, but some of it is insurance specific.
Potentially less pay per patient. While many insurance companies do pay less than the average acupuncturist would charge, some pay more. Typically insurance pays $40-50 per patient visit. The other side is that you can see that patient more often (often insurance has limits to the number of visits, but generally, not the frequency) and if you can see multiple patients in an hour, the hourly rate is not bad.
You may not get paid, especially in the beginning when you need it the most. Billing insurance is a skill and it takes time to develop. While one is developing the skill, there will be mistakes, and while most can be recovered from, some cannot. That means losing money. For the most part, this lessens to almost nothing as experience is accumulated. Not to mention, it is greatly lessened by reading a book such as this one.
It adds one more thing to worry about and keep track of. Running a practice is already a very difficult endeavor, adding another thing to the pot may be daunting.
Disorganized people will have a lot of trouble accepting and maintaining the systems necessary for insurance. But before the reader says, “Well, I am totally disorganized, therefore I can’t do insurance,” organization and building systems are skills, not traits, genetic or otherwise. In other words, anyone can learn to do it. But it does take the desire and effort. And some discipline in maintaining them.
What is probably the biggest issue is ideological. We as acupuncturists tend to eschew the mainstream, otherwise we would be doctors or nurses. We like being out of the box. Insurance is as squarely “in the box” as it gets. To accept insurance means, to some, we buy into the “whole screwed up paradigm of medicine in this country.” In the experience of the authors, this is probably the biggest hurdle to most acupuncturists accepting insurance.

There are obviously quite a few pros and cons to taking insurance, and many more than are listed here. Many acupuncturists the author has talked to have dabbled and then quickly retreated from accepting insurance. They will say things like, “I didn’t get any more patients,” “The paperwork was too much,” “I never got paid,” “It was too much of a hassle,” or “It just wasn’t worth it.” All of these things are true. And many, very successful acupuncturists have worked out such issues. Most of these issues are resolved by waiting longer and spending more time learning the ropes. Successful acupuncturists interviewed about this book said that it takes, just like building a practice, at least a year or two until all of the benefits of accepting insurance started appearing and the downsides started becoming less frequent or disappeared. So the take home lesson here is, if one does decide to accept insurance, it must be done for the long term. Do not dabble in it for six months and then give up.

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Making a Strategic Decision: Long-term Perspectives on Insurance in Acupuncture

Another consideration is that in many parts of the country, we may be where chiropractors were 15 or 20 years ago and medical doctors were 20 or 30 years ago. At those times (and still), they were complaining and moaning about how insurance pays so little and their livelihoods will become much less lucrative. It was a time of transition from basically a cash basis or lucrative fee-for-service insurance practices to managed care practices. They kicked and screamed the entire time and yet now, most of these medical practitioners are part of the insurance game. We wonder if acupuncturists are at this stage, where we are being forced both from patients and insurance companies to play the Game, even though we don’t want to. We may not have a huge choice. As a practitioner, are you going to be one of the bitter and resentful doctors bewailing the old days of easy money? Or will you realize this may be where our profession is, in all likelihood, inexorably headed and try to figure out the rules early and make not only the most of it, but actually thrive.

This is an excerpt from the new book, Playing the Game: A step-by-step approach to accepting insurance as an acupuncturist by Dr. Greg Sperber and Tiffany Andersen-Hefner being published by Blue Poppy Enterprises in the third quarter 2011. Dr. Greg Sperber is author of Integrated Pharmacology: Combining Modern Pharmacology with Chinese Medicine also published by Blue Poppy. He received a masters and doctorate of acupuncture and Oriental medicine from Pacific College of Oriental Medicine, San Diego, a medical degree from Flinders University of South Australia, and a masters of business administration from National University. Currently he is the Director of Clinical Services, Clinical Chair, and Professor at PCOM teaching, among other classes, practice management and insurance billing.

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