Unified Practice

On June 28th, 2012 the U.S. Supreme Court voted to uphold the constitutionality of the Affordable Care Act. It’s unclear how the overhaul of our current healthcare system will affect each of us, state by state but many acupuncturists are expecting a major surge in patients.

In states like California they have listed acupuncture as a benefit that insurers must include in new plans when the Patient Protection and Affordable Care Act, known as Obamacare, took effect on January 1st, 2014. For many practitioners the decision to list acupuncture as a mandatory benefit validates its effectiveness and breathes new life into many practices. Acupuncture now joins tobacco cessation, vision screening and other benefits that insurance companies must cover for patients under new plans and for existing plans that do not cover acupuncture, they will be grandfathered in.

As a result of Obamacare, health clinics, doctors, and traditional chinese medicine (TCM) practitioners alike are preparing for a new wave of patients coming in and receiving preventive care. This may seem exciting at first but despite a rise in appointments, some TCM clinics are actually expecting to earn less, per patient, for their services. The reason is that insurance companies tend to set a reimbursement rate lower than what some practitioners might charge per session. For example, say a practitioner charges $85 per session for the first appointment and $75 for every appointment thereafter. Depending on which state you are located in, you can expect insurance to pay you approximately $50 per session for the same treatment, with $25 coming from the patient’s co-pay. That is a significant difference in payment that adds up annually.

With coverage branching out to it gives an opportunity for more people to experience TCM treatments outside mainstream Western medicine. With that said, there very well may come a time when many practitioners decide to stop scheduling patients that are using insurance and fill in the remaining appointments with cash-paying patients.

Let us know your thoughts! Leave a comment below and let us know how Obamacare is affecting your TCM practice.