Patient Education: Understanding the Limits of Your Insurance Coverage for Acupuncture
In order to provide healthcare options to those who prefer to use their insurance, or those who cannot afford out-of-pocket services provided by acupuncturists- we have contracted with American Speciality Health.
In Newport Beach, only one of our acupuncturists works with a special insurance group called American Specialty Health (ASH). ASH supports some insurance plans like Blue Cross Anthem, Kaiser, Cigna, and others. Coverage is limited to chronic joint or musculoskeletal pain (excluding cancer, autoimmune conditions, or pain related to past surgeries), unless otherwise specified in your policy.
We are not directly contracted with your insurance, your insurance contracts with a third-party administrator: American Speciality Health (ASH). If your acupuncture coverage is not through ASH, we are out of network. If a providers name is listed on your insurance- then your insurance contracts with ASH. You can obtain clarification from your insurance company.
While insurance coverage often defines what’s included in your benefits, it doesn’t define the full range of care available to you, you may choose to pay out of pocket for anything not covered by insurance.
Dr. Shabnam Pourhassani, DACM, LAc, a state-licensed acupuncturist, is contracted with ASH. Coverage information can be found on your insurance provider’s website. Our goal is to ensure everything is clear so you know what is and isn’t included.
What Your Insurance Covers Through ASH
Insurance who contract with ASH only cover only certain conditions, in limited settings, and typically related to chronic pain management. Treatment must meet specific criteria for medical necessity. We cannot treat other conditions unless paid for out of pocket.
Appointments
Please arrive early. If you’re late, you will not be seen, or rescheduled. We have patients who drive to Newport Beach from Los Angeles, who are never late.
If your appointment is not cancelled 48 hours in advance you will be responsible to pay $120 for a missed appointment.
Chronic Pain: What to Expect
Your ASH acupuncture coverage aims not to cure chronic pain but may help manage symptoms. Progress is considered meaningful when:
- You’re using less pain medication
- Your pain intensity or frequency decreases
- Better sleep quality if pain is waking you up every night.
- You can resume daily activities like climbing stairs or loading a dishwasher
Improvement must be obtained to continue to receive acupuncture with most insurance plans.
Any patient testimonials for Dr. Pourhassani you may read online are NOT reflective of services provided under ASH contract. Those testimonials are of out-of-network services.
Acute Pain Is Not Covered by ASH
Insurance does not cover acupuncture for:
- Recent injuries
- New or short-term pain
- Pain after surgery
These services may be provided only if paid in full before the appointment.
A List of Services NOT Covered by ASH
The following are not covered and require private payment arranged in advance:
- Telemedicine (video, phone, email, text), unless the insurance pays for telehealth.
- Patient education, advice, or recommendations beyond how often to come in for acupuncture.
- Nutritional or supplement guidance
- Herbal medicine consultations or herb-drug interactions
- Lifestyle medicine
- Mind-body counseling
- Functional Medicine
- Holistic Medicine
- Emotional support
- Coaching
- Primary Care
- Lab test order, or reviews
- Diagnoses of new conditions
- Acupuncture in hospitals or outside the contracted clinic
- Case management
- Care navigation
- Questions about other conditions not pre-approved
- Relaxation or stress-reduction acupuncture
- Any alternative, proprietary protocol or other integrative services
Acupuncture for Relaxation
Relaxation acupuncture is not covered by insurance. These services require additional planning and are billed separately. If you’re interested in acupuncture for stress, anxiety, or general wellness, these treatments are available at an additional cost. Your insurance plans has a contract to purchase pain management services on your behalf.
Your Primary Care Provider’s Role- Patients utilizing ASH coverage
To use your insurance for acupuncture, you must have at least one licensed MD overseeing your care. ASH does not provide patients with diagnostic services provided by an LAc, or cover primary care services provided by licensed acupuncturists.
Payments: You can utilize your HSA or FSA to pay for services or copays.
Questions?
We’re happy to support your care within the boundaries of your insurance coverage. For services outside your plan, you may request a consultation.
What to Expect at Your Evaluation and Re-evaluation- Pain Management through ASH
During your initial visit, we’ll complete a brief intake focused on the specific condition covered by your insurance. To help us provide the most effective care, please be prepared to answer a few important questions about your pain:
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Where is your pain located?
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Does the pain travel to other areas?
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Does the pain affect your sleep?
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Does it interfere with any daily activities?
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On a scale from 0 to 10, how would you rate your pain?
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How often do you experience the pain?
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What tends to improve it?
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What tends to make it worse?
Your follow-up visits will include acupuncture treatment only.
Limited insurance plans contract with American Specialty Health (ASH)- Each plan has different coverage-
- For Medi-Cal ASH plans, you are eligible for acupuncture twice per month.
- Under Kaiser Medi-Cal plans, referrals from a Kaiser physician are not required. Coverage excludes evaluation and re-evaluation services and limits treatment to two visits per month.
- Other Kaiser plans allow five visits for your initial diagnosis. You will have an evaluation, 4 acupuncture visits, followed by a re-evaluation if deemed medically necessary.
- Some Kaiser health plans require specific evaluations and medical-necessity authorizations to continue treatment. We only request additional visits if you are demonstrating improvement.
- Evaluations and re-evaluations are covered by certain plans; however, they cannot be scheduled on the same day as acupuncture treatment.
- Medicare Advantage plans may be limit acupuncture to one diagnosis- chronic low back pain (cLBP)-you will only receive acupuncture for what is covered.
- A 48-hour cancellation notice is required. If you cancel, reschedule, or do not show for an appointment without proper notice, you will be responsible for a fee. If more than one such incident occurs, you may be discharged from Dr. Pourhassani’s care and will not be able to schedule future appointments.
During Your ASH Acupuncture Session
On the days of your acupuncture appointments, you will sit, or lay down- the areas to be treated will be gently cleansed with alcohol wipes, sterile, single-use needles will then be applied using a gentle technique- there will be no talking during this time.
A Note to Previous Patients of Dr. Pourhassani
“Services provided under an ASH (American Specialty Health) contract are not equivalent to services offered through self-pay or out-of-network plans. Care delivered under ASH coverage follows a different treatment model, including differences in visit structure, time, and scope of services.
For this reason, I do not recommend traveling long distances to see me if you are using ASH coverage and expecting to receive services comparable to those that typically cost approximately $250 out of pocket at no cost.
Patients seeking the depth, time, and clinical approach associated with self-pay or out-of-network care are encouraged to explore those options directly.
Thank you for your understanding and for making informed decisions about your care.”
Warm regards,
Dr. Shabnam Pourhassani, DACM, LAc
Notice Regarding Pro Bono Services
At this time, we no longer provide pro bono services, as external funding for these services is no longer available.
We remain committed to community access to care and welcome donors who are interested in supporting the foundation so that pro bono services may be reinstated in the future.
Thank you for your understanding and continued support.