Acupuncture coverage varies from clinic to clinic and navigating the funding system can be complicating. As a general rule, Western Acupuncture is completed by Physiotherapists or Chiropractors. Traditional Acupuncture is administered by Acupuncturist or Traditional Chinese Medicine (TCM) practitioners.
Payment Options for Acupuncture
If you need acupuncture, let our team help you navigate the funding systems. Most patients are unaware of the benefit from their insurance plans and other funding sources. Contact our team and we can help. ask@albertaPT.com . Below are the 3 most common ways of accessing acupuncture care.
1. Private Insurance
Most patients who are employed are covered by a Group Insurance Account or a Health Spending Account through their employer. For patients who have Group Insurance, the benefits for acupuncture range from 100% coverage, to partial coverage with deductibles. When looking into your plan, you will need to know:
If you have a health spending account, you will need to ask your employer your yearly maximum amount and who to submit your receipts to. Many employers will offer both the Group Insurance and the Health Spending Account so that access to acupuncture is fully covered.
For patients who are married and both partners have insurance, the process can be somewhat more complicating and does vary from case to case. To maximize your benefits, you should talk to the clinic administrator prior to your visit.
If acupuncture is administered by a registered physiotherapist (PT), you will only be able to access funding for physiotherapy.
If acupuncture is administered by a registered acupuncturist (RAc) or Traditional Chinese Medicine (TCM) practitioner, there is typically a separate funding pool.
All AlbertaPT clinics provide direct billing to insurance, if available.
2. Motor Vehicle Insurance
If you were injured in a car accident, acupuncture administered by a physiotherapist is completely covered by the Automobile legislation. Accessing funding does require paperwork to be completed by both the patient and the physiotherapist. If you are assessed within 10 days of the car accident, you can qualify for either the WAD 1 or WAD 2 in-protocol programs. For out-of-protocol programs of care, legislation requires private insurance be accessed first, with the remaining unpaid balance covered by the Automobile Insurance.
The rate charged per visit will vary depending on the level of care and the amount of data collection required. When in-protocol, you are covered for the Regular Visit Rate. When out-of-protocol, you are covered by either the Comprehensive Visit or Complex Visit Rate.
If you are seeing a registered acupuncturist (RAc), the total out-of-protocol funding is $250.00.
Navigating the Automobile Accident Insurance Benefits and dealing with adjusters can be a complicating process. Let our Care Coordinator assist you with the process.
3. Worker’s Compensation Board
If you are injured at work, the Worker’s Compensation Board covers acupuncture administered by a physiotherapist for 6 weeks with a maximum of 21 Visits. If all the required paperwork is completed, most acute injury claims are approved. For chronic conditions, pre-approval of services are required prior to treatment.
If you are seeing a registered acupuncturist (RAc), WCB covers an initial assessment and 7 treatments.
The mandate of WCB is return to work and exercise. As such, the WCB fee is for a Basic Visit only. In certain cases where more than 2 areas are injured, WCB may recognize a modified Comprehensive Visit. During a WCB visit, the physiotherapist is only to treat the areas recognized in the WCB claim.