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It’s Not Working

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Healthcare is a huge, huge cost in the US. Our healthcare expenses are about half the size of the complete Chinese economy! Our healthcare makes up 1/6th of the economy.  Of every hundred dollars the average American spends,  $16.52 goes to healthcare.  $238,000,000,000 in 2008 alone.

This is just sick (pun intended).

Isn’t this telling us something?  I think so. Two things:

  1. Americans are sick.
  2. Something is not working.

Americans are Sick

I believe the average American adult is ill.  I have a friend who is a medical transcriptionist.  Instead of taking notes by hand, doctors dictate patient notes and she types them up.  She’s “amazed” at how many people are taking 5 of 6 drugs.  Some of them are taking drugs to counteract the side effect of drugs!

In 2007 there were 3.8 BILLION prescriptions filled.  This is 12.6 for every man, woman, and child in the US.  As far as I’m concerned, if you’re taking a drug, you’re still sick.  The illness is there, but even if the symptoms aren’t.

Something is Not Working

Obvious.  If they’re not getting better, of course healthcare isn’t working.

This is why I like acupuncture and Oriental medicine so much.  It works, it works well, and it’s usually a true cure.

This is also why I’m annoyed with the “Obama” healthcare plan – The Healthcare Reform Act.  The whole debate is misleading. It’s not addressing the true problem – “modern” healthcare is behind the times.

What do you think should be in “The Healthcare Reform Act”?  What would you like to see happen in your country?

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46 responses so far ↓

  • 1 Jill // Aug 24, 2009 at 10:33 am

    I think it’s our patriotic duty to get our name out there and promote our art. By healing more people we’ll bring down healthcare costs. There would be fewer hospitalizations and people would be much, much healthier.

  • 2 Andrea // Aug 24, 2009 at 12:31 pm

    A couple of months ago, I attended a local hometown meeting where consumers and providers of health care shared their experiences and thoughts. This was not organized by any governmental agency – just some concerned citizens having a brainstorming session.

    We all agreed the direction our president is going is not true “reform”, and our suggestions surprised all of us.
    Yes, we all wanted to see unhealthy medical practices replaced by health-affirming modes, and we all agreed on making health care more widely available to all. We also were in agreement about lowering costs to the consumer and practitioner alike, and acknowledged with great frustration the power that the pharmaceutical and medical lobbies have over health care as practiced in the USA.

    The majority of us wanted free, government-provided health care, though I personally feel a need for more information before agreeing on this. There was lack of agreement about continuing to expect employers to provide health insurance, but unanimity about the health insurance system as it is, being totally corrupt and inadequate, focusing more on looking for ways to deny care and reimbursements, than anything else.

    However, the item which surprised me most, was unanimous agreement on placing greater responsibility for maintaining health on individuals. The model we sketched out, was to offer free health care to those who have healthful diet, exercise, stress management, and other lifestyle practices; and to require those who are ill through their own poor health care practices, to pay for their own health care if they are not making more healthful changes. I know, it sounds harsh and shocking, maybe even punitive, but also quite logical.

    This response does not address the direction the national health care “reform” is taking, but it definitely provides an interesting and unexpected view of public opinion about willingness to place greater responsibility for self-care, even and especially where cost is concerned.

    Lastly, it was also agreed that complementary therapies should be included in all health care discussions, and that all practitioners of these therapies should be compensated fairly, without meddlesome interference by insurance companies.

  • 3 Elyse // Aug 24, 2009 at 12:34 pm

    I think the Obama health plan is at least a step in the right direction bringing attention to a system that is out of control. Obama has also mentioned acupuncture in a positive light. I think that much refining will have to take place to get this bill passed, but I believe that it will be a life saver to the multitudes that cant afford, or are not insurable by the major meds. Let’s give these companies a little competition so they can work on keeping things in check (costs to consumers). I definitely think that this is a step in the right direction, and anyone who doesn’t see it as so, is pretty short sighted.

  • 4 GOFORTH // Aug 24, 2009 at 12:53 pm

    It should be called The Sickcare Reform Act. As long as allopathic medicine is king, symptomatic treatment will prevail and, of course, the cause or real problem will remain for both the patient and our healthcare system.

    L.M. Goforth

  • 5 kellie // Aug 24, 2009 at 1:01 pm

    Here’s a startling statistic that should light a fire under ALL of us to enact some significant change:

    The U.S. is 5% of the world’s population & we consume 70% of the pharmaceutical supply.

    I regularly call, write & email my representative and senators to let them know I support reform, but do not support the existing policy of “Healthcare = take a pill”. When did our healthcare system begin equating writing a prescription for pills with actual Health CARE? I make sure tell them I’m a L.Ac. & as such, am many of my patients’ Primary Physician. What are the plans to include complementary medicine in the reform?

    I believe all of us have a responsibility to vote, and to continue to contact our government officials if we truly expect to be heard! Ask your family members, friends, and colleagues to bombard their representatives with these concerns.

    How will they know the changes are wanted and needed if we don’t let them know?!

  • 6 Liz // Aug 24, 2009 at 1:28 pm

    You should have not entered into the political debate. You lost me on that.

    (Posted from email, someone who unsubscribed. – B)

  • 7 Elyse // Aug 24, 2009 at 1:44 pm

    If you are thinking that a MAJOR paradyme shift is going to take place overnight, and homeopathic medicine is going to become the treatment of choice over allopathic medicine…..Stop dreaming/smoking whatever it is you are smoking! The big Pharm companies which run the economies of the 1st world nations are not going to let that happen soon. HC reform is at least a step in the right direction. It is a step that we are starting to take back control of how the system works, and eventually over time, we might be able to institute reform concerning the quality of our care. A major paradyme shift is not going to happen overnight!

  • 8 Billy // Aug 24, 2009 at 1:49 pm

    The government can not fit the unhealthy people in this country. This country as a whole dose things the wrong way. We need to hold the people accountable for there actions. If you eat bad foods then you will not be healthy. We have taken PE (gym) out of the schools. To say you are going to reform health care is not going to make people healthy or make better choices.

    Acupuncture will not be in any health care reform why you ask, The Standard Occupational Classification Policy Committee (SOCPC) of the Bureau of Labor and Statistics at the U.S. Department of Labor does not consider acupuncture and Oriental Medicine a Standard Occupation, based on Classification Principle 1, which states that occupations are assigned to only one occupational category and Classification Principle 9, which states that for a detailed occupation to be included in the Standard Occupational Category, either the Bureau of Labor Statistics or the Census Bureau must be able to collect and report data on that occupation. Based on the information received, neither agency has been able to determine it would be able to collect and report data for acupuncturists

    For Acupuncture to be included in any health bills HR 646 would have to pass. That would change the way they view acupuncture. HR 646 has been around since 1993 (16 years) this bill is going no were.

    I think that the people trying to pass this bill need to look at then own health. Maybe stop smoking first. I know that most people around the country don’t take insurance or insurance in there state dose not pay for acupuncture but some states to pay and pay really well. I know that Maryland has a really go reimbursement
    rate for acupuncture. Maybe other states could do what they have done you we are will be in a better boat.

    If you take on thing from this post take this. People buy what they want, and beg for what they need. I found it hard that some one who worked for 40, 50, or 60 years can’t afford a 20 to 30 dollar acupuncture treatment. That is about what CA centers around the country ask for payment.

    The people are going to make them self’s healthy not the government. The government at this point is time is not healthy.

  • 9 Bonnie // Aug 24, 2009 at 2:00 pm

    I think that the health care reform act isn’t about healthcare–it’s about insurance. We should be calling it what it is: the health INSURANCE reform act.

    I think health care changes come when we start changing our paradigm of health care (like Elyse says). At some point people will change, but right now our government is working on getting everyone access to something.

    I am for a public option which will lower premiums across the board. More people will have insurance and access to the first type of healthcare that they know about. When they don’t get what they need, they come to us–and they pay us out of pocket because they have more spending money. They no longer feel bound to use what their insurance company provides because they aren’t paying them so much. As people learn how much more we can do and the paradigm shifts, we’re likely to be compensated for our efforts at a much higher rate than we are now–and I’m speaking about what we are paid per patient by the average insurance company, which hasn’t changed in 10 years.

  • 10 Dennis K OMD, RPh // Aug 24, 2009 at 2:42 pm

    Interesting! I agree. We should all become aware that our “health care system” is controlled by the oil cartel. All pharmaceuticals (synthetic drugs) begin at the oil wells. The chemicals that go into making our artificial drugs are refined from petroleum products. The Rockefeller clan, the Carnegie Fund and others set up our “modern” medical system nearly one hundred years ago thru influence peddling and “purchasing” systematic legislation to discourage and even outlaw natural medicine and healing in favor of this incredibly lucrative, dangerous and short sighted medicine we are trapped in today. The establishment uses disinformation and fear to “market” their ideas thru a corrupt “news” media in order to keep us enslaved to petrochemicals. If you doubt this just watch the “debate” and see the tactics they are using! We slipped in unnoticed by the powers that be because they held Oriental medicine in such low regard. Now, as it makes more and more inroads, they are waking up to the threat and successfully banning herbs and preventing us from freely practicing in hospitals and other venues. Only by education of those who are unaware will we pull forward together but don’t expect it to be easy or without a fight.

  • 11 Elyse // Aug 24, 2009 at 3:01 pm

    If HR 646 were to pass, it would be a shift in a more positive direction. It probably would be one of the best things that could happen to us as a profession. I dont care what you think of medicare, the paperwork, that rates offered….It would be the main gatekeeper to Major med’s acceptance of acu. NO ONE says you have to accept insurance, but it would place us on a more level playing field with other practitioners. I’m sorry to say this, but we have ourselves to blame for keeping this problem self sustaining. Too many people are not at all business savy, or have business models based upon clinics from China (hospitals) which dont translate very well to our cultural climate or economic model. Too many different factions…I personally would like to know that why in NYS (where I practice), I’m not considered an “allied” practitioner (whatever the hell that means). Why isn’t the dept of education (who licenses professions) protecting the fact that I am a liscensed professional . I find it not only demeaning, but an excuse for insurance companies (whom I’m an in network provider) a reason not to pay. We get treated like the poor relation, because we act like one. I suggest that everyone get together and pray for health care reform (insurance reform) to start bringing this matter to the forefront.b

  • 12 GOFORTH // Aug 24, 2009 at 3:03 pm

    Dr. Dennis is right. It has a lot to do with the Rockefeller’s. They funded the Flexner report which classifies what is the norm (medical care) and what is ‘alternative’ health treatment methods- acupuncture, chiro, healing herbs, homeopathy, etc…this explaineds why the current system is the way it is. Studies have been done by all types of alternative healthcare providers which revealed the massive amounts of money that could be saved if conservative, natural approaches were used. Unfortunantly, these studies are ignored, and since the same people own the media, the research findings never see the light of day as far as being told the general public.

  • 13 Billy // Aug 24, 2009 at 4:09 pm

    How would HR 646 help. Once again most people who have Medicare are not poor. They have worked all there life. I have patients that come to me that are on medicare. They pay less then working people, I give them a discount. A public option might be illegal the way our laws are set up.

  • 14 Elyse // Aug 24, 2009 at 4:20 pm

    What universe are you living in? ” Medicare patients are not poor”?? There are multitudes of retired people who struggle to make ends meet each month, especially with higher costs of living, economy etc. Medicare is the gatekeeper for the major meds. If you want to offer a discount go right ahead. This “discounting” thing creates a problem with our services being valued. DId you ever hear of an optomologist or a neurologist give a discount? Dentist? Sorry, i just cheapens what we do in the eyes of the public. Medicare has it’s administrative problems (Im sure) but I still think we would be MUCH better off if we wee bonified medicare providers.

  • 15 Billy // Aug 24, 2009 at 4:41 pm

    I saw Bonnie say “we’re likely to be compensated for our efforts at a much higher rate than we are now–and I’m speaking about what we are paid per patient by the average insurance company, which hasn’t changed in 10 years.” I don’t know were you live but today I am going to share with board my mail from today. I two checks today in the mail. One from BC/BS and the other from Cigna. My BC/BS check is for the same person and two treatments. I billed a 99204 at $170 I got $117.60. I also did three units of acupuncture, First one was 97813 and two 97814. For the 97813 I got $33.72 for the 97814 I got $27.32 times two, and 97014 (piezo pen) $10.46 plus the patient had a $20 copay. first treatment was $236.42, the second treatment paid me $118.80 total check was $355.22.

    My second check was from Cigna, I bill a total of three units, one 97813 and two 97814. For the 97813 I was paid $44.80 and for the two 97814 I was paid $38.85 each. The patients also had a $20 copay for a total $142.50.

    I made a total $497.72 for three treatments. I make good money and you could too. Say far away from the government.

  • 16 Elyse // Aug 24, 2009 at 4:56 pm

    I have to llok up 99204, usually I bill for 99203 for the first. You’redoing well with ins. co’s Here in NY BC/BS is a real horror. They pay for squat: nausea during pregnancy, chemotherapy (nausea) and osteoarthritis of the knee. Big range of things to treat with them. If we were able to tx medicare, we would be able to treat in all ins. companies. We would be accepted as a “standard” and recognized practitoner.
    Fixing the HC system (insurance) goes way beyond our paycheck. There are so many people that cannot afford basic checkups, and god forbid if some disaster happens, they’re screwed completely. Only the rich, very poor and those with good health benefits from a job can afford decent care.

  • 17 billy // Aug 24, 2009 at 5:09 pm

    I know other states don’t pay not much, that is why I am not moving. IF the government would pass a co op bill that would allow people to buy insurance in a diffent state then in witch they live, then you would have the same rates as I do. Right now it is the government who will not allow people to buy insurance in other states. The price of insurance would also go down in price and people could come together an buy insurance as a group.

  • 18 Elyse // Aug 24, 2009 at 5:16 pm

    What state are you in? I am a BC/BS provider, but have to refuse taking the insurance from 98% of the people insured with BC/BS empire. I had a very bad experience with a Horizon BC/BS patient. NYS does not talk to NJ, BC/BS is probably the worst. Cannot get a human being on the phone. After you go through all the prompts asking for every number you were ever assigned since birth, then it will tell you all reps are busy and to call back etc. etc. Horrible, fradulent bastards! If there was a national plan, these people would have to clean up their act. Their would be competition that is cheaper and couldn’t be any worse!

  • 19 Bonnie // Aug 24, 2009 at 5:41 pm

    I live in Washington state. New patient rates have gone up slightly–mostly because of the change in the examination. The others have stayed pretty much flat for the acupuncture reimbursement. We had to fight to keep the insurance levels the same when we changed the codes from the single code to the double. One of our insurers tried to pay us LESS than we were contracted for based on the reimbursable amounts.

    Most places here will ask for chart notes and delay payment for three units of time even longer so in general we bill for two units. I’ve never had anyone pay anything for any of the supportive therapies like massage and such. These are written off as 0.

    I don’t know what state you are in Billy but your insurers are paying way more than we get here!

  • 20 billy // Aug 24, 2009 at 6:09 pm

    I live in Maryland. Just talk to any acupuncturist who lives in Maryland and they will tell you about how well we are doing. We get paid on 15 differnt codes. BC/BS gave me over the phone the exact amount they will pay me for each code. I some times run into a out of state insurance policy that will say only and MD or a DO can do acupuncture and get paid for it.

  • 21 Bonnie // Aug 24, 2009 at 6:18 pm

    Well obviously they have different laws. However money isn’t everything so there’s no way I’m moving!

  • 22 Elyse // Aug 24, 2009 at 7:10 pm

    Billy,
    What is code 97014? Also, are you in network or out of network? Just wondering why you got paid so well on the codes. Much better than NYS

  • 23 clayton // Aug 24, 2009 at 7:14 pm

    In order to reform health care you must get control of costs. This is a three step process.
    1) Tort reform limits to a maximum of $250k payout regardless of the case.
    2) You eliminate all access for Illegal aliens to any and all health care facilities nationwide. If you are not a legal citizen then you have no right to care as you don’t belong here in the first place therefore illegal’s should not get health care of any type or kind.
    3) Co-payments min of $25 per visit for every office visit or hospital visit.no exceptions
    Thank you very much.

  • 24 Bonnie // Aug 24, 2009 at 7:17 pm

    Elyse, Some of it may be cost of living. I never noticed a difference between Seattle area pay and a more rural area where cost of living is way down. I wonder if they have a general state by state cost of living and so larger states that have lots of rural areas get paid less in general? I don’t know how they figure, but Billy is getting way more than we normally do here too.

  • 25 billy // Aug 24, 2009 at 7:43 pm

    I am a BC/BS provider. Here in Maryland you get more money if you are not a provider. But as a provider I am in there book and get patients from them. Here are some of my codes and this is what BC/BS pays me per 15 minutes. 97014 eletric stim (unattended- TENS unit) $11.39

    97032 elertic stim (manual I use a device called inter-x by NRG and piezo pen) 10.46

    97028 ultraviolet light (I use a Bio Matt) $14.50

    97016 suction or compression (moxa or cupping) $16.75

    97110 therapeutic exercise (ROM and flexibility) $19.25

    Use can use all these code along with your 97811-97814 codes. With federal BC/BS you can use a 99212-99213 with ever visit. I don’t because it might send up a red flag but you can.

    You can bill more then 15 minutes but your notes have to back it up. I write a lot of notes, the more the better. I see one patient a hour.

  • 26 Bonnie // Aug 24, 2009 at 7:49 pm

    Our BC/BS only allows 99212/99213 with each new diagnosis or if the patient hasn’t been in a long time. One of my friends was audited and charging every visit is a no no–at least in our state.

  • 27 billy // Aug 24, 2009 at 8:26 pm

    The Federal program is the best program for BC/BS. They are the only ones that allow it. Most if not all others allow a follow up code visit once every 4th visit. There is a bill called HR 818 that would allow acupuncturist to treat federal works. He in Maryland a few years ago only MD’s and DO’s could could bill federal BC/BS works. But the people who have this policy called BC and said MD’s and DO’s are not taked new patients or they don’t take
    insurance. Just by people call they (BC) changed there policy. The bill is still active I believe they added something new to it. But it is your patients who really have the power.

    Down here in Maryland the closer you live to DC the higher your rates will be. BC/BS use your office zip code to come up with your rates.

  • 28 Elyse // Aug 24, 2009 at 8:47 pm

    That is so surprising what you state about rates. One would think that manhattan would merit getting a high rate. Especially due to the cost of expenses, rent etc.

  • 29 Bonnie // Aug 24, 2009 at 8:51 pm

    Another factor in what you can bill and get paid for depends upon the employer. There are some BC/BS plans that are unique to the employer–for instance Boeing will not pay for the initial visit, only the acupuncture part. Also all BC/BS tend to differ from state to state–Oregon BC/BS is different from WA BC/BS, so it’s both the state and the insurance and the employer that determines whether they pay for something or how much they will pay for it. However, if you are contracted with the plan they can only go so low.

  • 30 billy // Aug 24, 2009 at 9:03 pm

    Back to one of my points if your patients can cross state lines and buy insurance in Maryland that would take acupuncture into a whole new world over night. If you and every other acupuncturist made what we make it would change the country for the better.

    Here in Maryland we give classes on how to bill insurance. The guy who teaches the class Sam Collins is on BC/BS board. I don’t know what he does on the board.

    They about two classes a year on this stuff.

  • 31 Bonnie // Aug 24, 2009 at 9:24 pm

    The office managers at both of my offices has taken several insurance billing seminars. One was from RBC of Oregon. There they learned that you never take no for answer or they will deny claims for you more often. A helpful tip that no carrier ought to be able to do!

    I have gone to several of those classes as well so I am pretty well versed in what I can legally bill in Washington. What I don’t understand is if I can’t legally bill something in Washington that you can legally bill in Maryland, then does it matter what insurance carrier my patient has?

  • 32 billy // Aug 24, 2009 at 10:37 pm

    Each state has it own laws and what you can and can’t do. Here in Maryland we have had a lobbyist for many years. I would say 15 years or more, her name is Neily Mutch. If I have a question or problem I call her up or I take her out to lunch. She has been an lobbyist for many years and she puts our state board in contact with the people who make the laws.

    If your state org’s dose not have a lobbyist they should get one. Sam from AAAOM works for them Not your state, I have met him and he is a nice guy.

    If you are seeing BC/BS patients you should by law be allowed to bill the same codes I do and get paid for them. I have said this to the AAAOM as of this April this year, use Maryland system as presidence. Make the insurance company’s pay you the saw way they do here.

    I have been saying this for years. It falls on deaf ears. If you make a good living you could see medicare patients for little to no money. I have been given cookies to bread for payments. Don’t turn them down they will get mad. I also treat all vets and there family’s for free. They can come as many times a weeks as they want.

    The more and acupuncturists makes the more good he can do for people.

    I thought that New York acupuncturists also were paid good rates. I was in a meeting two years ago in Portland and two guys from the Washington state org were there and they said they state org was them and that was it. They were wearing many hats. I felt bad for them two guys, I forget there names both one was the president and the other one was the vice president.

  • 33 Bonnie // Aug 24, 2009 at 11:02 pm

    We have a good state organization and a lobbyists. I have worked to get involved with our state organization but they are not good at follow up–difficult to get a hold of them. I suspect there are others who have had an interest but never get any follow up so they forget, as did I or figure there are other people who are doing the job.

    When I was in my own office and did cash only for a short time, I’d lower rates. People are funny. They don’t like to have to have you slide down even you say you do it for a lot of people. I always told them it was good karma. People are proud though and don’t want to be beholden. I think this is very different from the attitude that we hear about–that everyone wants a hand out.

    I don’t worry about payments going down. They can only go up really. However even if we don’t get a lot directly from an insurance reform the lower cost of what people have to pay their insurers helps us indirectly as they have more discretionary income and are more likely to seek us out even if they pay out of pocket.

    Do your insurers only offer 12 visits? How do you work that with your chronic illness patients or those who have something very acute and need more than that? This is a huge issue here as most carriers offer only about 12 visits (some 15 and one lifewise plan offers THREE–wow! What a deal!). A few do offer more but almost no one is unlimited any longer.

  • 34 Elyse // Aug 25, 2009 at 4:07 am

    Here in NYS we have an organization called ASNY. A really lame bunch, always taking issues from the back burner and leaving the important issues out. The last big thing they were fighting for was getting herbs as part of out scope of practice or something like that. Never mind the fact that some insurance companies will not pay a L.Ac., becuase we are not considered an “allied” practitioner. United health care will pay a certified MD (250 hours) and not pay a L.Ac.! I gave up on them…I tried, but really a total bunch of lame people. Many L.Ac.’s here think it is somewhat beneath them to accept insurance. They state that if one does proper marketing then a lucrative cashpractice is very possible. Well…I don’t think that is true for everyone. I have a portion of people who pay cash, but many don’t continue on in tx. due to out of pocket expenses. Then there are those who start “community style” clinics and charge a sliding fee of $20-$40 A TX. I don’t think this model works in the long run for the benefit of either the patient or the profession. In China these clinic are run by the govt, and paid for by the govt. Working for such little money (and giving only 15 minute tx) is not the answer. In fact, the ins. companies when creating a fee schedule can point them out and say …”See, this is the current rate that people are charging” Not good.
    I think it would be a tremendous turn around if we had medicare privileges. Not going to rehash what I have already stated.

  • 35 Juliette Aiyana, L.Ac. // Aug 25, 2009 at 8:13 am

    Check out the response on healthcare “reform” written by Dr. Andrew Weil on Huffington Post.

    http://www.huffingtonpost.com/andrew-weil-md/why-i-am-a-conservative-o_b_259869.html

  • 36 billy // Aug 25, 2009 at 10:47 am

    Elyse here in Maryland we have a law that dose not allow insurance company’s to discriminate. If they pay a MD or DO to do acupuncture then they also have to pay L.Ac’s. They also can’t pay MD’s or DO’s more money for the same codes. We have had that law on the books since the 1980′s. In our state L.Ac’s can join the MD acupuncture society. I am a member and I even help them out on there board. I am not a member of the AMA so I can not be a full board member. When we have a problem with the insurance company’s out state group and the MD’s group go an talk together. We did that a few months back. I am really good friends with all of the MD’s I even sent them patients.

    Yesterday I gave you the codes I use and what BC/BS pays for them. The plan I told you about is called BC/BS indemnity. That plan I told you about and that patient gets 50 treatments per year. That is what most indemnity policy’s give. The Federal plan allows 24 treatments per year. About two years ago they give only 12 treatments. Now it is up to 24 and I have hear it might go up to 36 treatments in a year or two. I also have a few patients who have unlimited visits. As long as it is medically necessary. So as long as my notes can back it up they pay. I have a patient who has Cigna and she has this plan. I have been seeing her once a week for the last three years. I give notes with every treatment.

    I also see patients that have BC/BS PPO that gives them 30 visits per year for acupuncture or PT. You use all 30 for PT or acupuncture split them up any way.

    The only BC/BS policy that dose not pay for acupuncture is blue chose HMO. I am sure that there are other BC/BS plans I don’t know about that don’t have acupuncture but I have not ran across them. I was talking with my biller and she told me something. I have see patients who have both medicare and BC/BS federal plan. One was retied and the other one was still working, they were both over 70 years old. I got paid for there treatments. I don’t know much about it and I don’t think I want to know. But she said sometimes when medicare says no BC/BS will pick it up. I am sorry I don’t know more details about this but that is over my head.

    BC/BS dose keep a list of all that you bill. I know a guy in my town who got a letter and it said you are billing more 99205′s them most other acupuncturists in your area. They will come after you if you are up coding. I even know a few cases were they took people to court and won.

  • 37 Adrian // Aug 25, 2009 at 5:39 pm

    Something needs to be done about Big Pharma

  • 38 Elyse // Aug 25, 2009 at 10:49 pm

    Hi Billy,
    It certainly is not fair. Here in NYS we take a back seat to MD’s.. MD’s who have 250 hour certification courses get paid from United Health care, and we can’t. BC/BS (empire) in NYS is th worst. They only will pay for: nausea from chemo, nausea durign pregnancy, osteoarthritis of the knee. They have the nerve to say that other diagnoses are “not proven effective”. How can this be when the same company pays in other geographic locations? This is why I would personally like to see HC reform. To take away some of the power of the Dr, ins company Mafia.

  • 39 billy // Aug 26, 2009 at 11:18 am

    Hi Elyse, I agree with you 100% about doing something to change health care. It is not fair. I have been saying this for over five years. I am trying to do something about the reimbursement rates around the country. I have talk to just about every people who will hear me. There is this group of state presidents that have a message board. The president of your state org is on it. They are talking about changing the way things are done and getting every state to have close to the same rates. This is a first step, I hope some change comes out of this.

    The medical acupuncturists have a national association. There president id Dr Richard Neomztow, He is like my father. I work with him one day a week. We have talked about the MD and L.Ac’s coming together and changing the system. When I wen to the national conference this is Sacramento I gave a message to the AAAOM CEO that Richard would like to met with them and build a bridge of friendship. I found out from Richard last week that about a month after I gave them the message they flow into Washington to met with him.

    I hope that he can help us help our states fight the insurance company’s to be fair. We are for health care reform, but it is going to be reform from the people to the insurance company’s.

    Just today Richard was telling me that doctors in org are telling him insurance company’s are not paying them well. He said that a lot of MD’s are going to stop doing acupuncture and the L.AC’s are going to have to pick up the patient load. That is what happened here in Maryland and that is why BC/BS started to pay L.Ac’s for there federal program.

  • 40 Elyse // Aug 26, 2009 at 12:24 pm

    Hi Billy,
    If you would like to continue our conversation tete a tete Here’s my email address: elysejosephs@gmail.com
    I have a lot to say about the “medical acupuncturists” most of which is not very complimentary. Thanks for all your efforts. Elyse

  • 41 Dennis // Aug 26, 2009 at 3:35 pm

    I keep reading on here that some people are of the belief that what we are talking about is “free” health care for all Americans. Sorry, there are NO free lunches and there is no FREE health care unless every practitioner and hospital in this country, including acupuncturists decide to GIVE AWAY there treatments and live under a bridge somewhere. This WILL be funded just the same way everything else is funded in government, either thru taxes or thru deficit spending. You and I will have to pick up the bill. The question is: will that tax bill be more or less than what we are now spending out of pocket for health care? I am hoping that the taxation will be less than what I am now spending out of pocket for health care insurance. Will I continue to spend my own money on health care? OF COURSE! Our own “health” is our primary responsibility. Yes, before we buy those Audis or Lexuses or even Chevy’s for that matter, before we have those weekend jaunts to Vegas or purchase a new game boy or even another pack of cigarettes, we need to spend money on our own health. What a concept! It used to be called “taking responsibility for our SELVES.”
    Don’t get me wrong, I believe the health care “debate” we are going thru is good. The trouble is that it is not about health care, it is about WHO will PAY for health care and HOW MUCH it will cost. Time to wake up….in the end, there is NO “free health care”……..

  • 42 Elyse // Aug 26, 2009 at 4:25 pm

    You are right, nothing is for free. But there is something called “priorities”. Perhaps how the gov spends our money should be prioritized. So much is wasted that could be put to good use. Also, the waste within the medical profession. the insane charges for testing that only confirms the appearance of symptoms (but gives hard evidence) that charges ins. companies thousands for each test, and does NOTHING to actually ammeliorate the condition. Even the mid set of people. I know women that will spend humdred’s on their hair, and their bodies are falling apart. Priorities…

  • 43 Dennis // Aug 26, 2009 at 9:18 pm

    I agree. Especially the corrupt and stupid way insurance companies allot the money for “health care”! Since when did cutting a critical organ or joint out of a patient’s body and tossing it in the trash become confused with “treatment” or a “cure”? And yet that is exactly what insurance companies have been programmed to accept as an acceptable level of “health care” in our country. And they (we) spend BILLIONS and BILLIONS of dollars a year on this insanity.
    Last year a patient came to me with gall stones. Of course her MD had recommended removal of her gall bladder. After her diagnosis she ran into one of my patients who told her to call me because I had educated this patient as to the other benefits of acupuncture and Chinese herbal medicine. Six months later her gall stones were gone at her next check up and she STILL HAD HER GALL BLADDER! The average cost of gall bladder removal is about $26,000. Acupuncture and Chinese herbal medicine cost this patient, out of pocket…she had no insurance… just under $2000… and SHE STILL HAD HER GALL BLADDER!! There are roughly 500,000 gall bladders removed in our country every year at a cost (if there are no complications) of $13 BILLION per year….. if patients tried our medicine FIRST we could save the system $12 BILLION per year! We know this …. but how many doctors, pharmacists, nurses and patients, ie other Americans… know this?

  • 44 Dennis // Aug 28, 2009 at 3:01 pm

    Wow! Thanks for the link to Dr. Weil. He has nailed this one. Too bad he wasn’t given even more space to go into greater detail.

  • 45 Burton Kent // Aug 28, 2009 at 3:27 pm

    I just wanted to say thanks for all your comments. Especially you, Billy – people need to know how to deal with this.

    When I got in and saw 23 comments in my email, I was kind of freaked out. I thought that the comments probably devolved to a political debate – the web equivalent of people yelling in my living room.

    It was nice to see that it was an informative and informed discussion instead!

  • 46 SuperMe // Dec 7, 2009 at 3:07 pm

    Great point, Dennis. It really brings up the notion of “what’s expensive”.

    Many community acupuncture advocates shout at those of us in the private practice model saying we are too expensive. When you begin doing the math, $2,000 versus $25,000 looks pretty convincing, doesn’t it? On top of that, you can probably add another $2,000-$50,000 in savings from the future side effects that would finally ensue from, oh say, missing your gallbladder over a lifetime.

    Don’t get me wrong. I think the CA model is a pretty good response in our current state. It’s a market response and a market demand. However for the acupuncture community at large I think it is important to point out that we are cheap no matter what our prices are, at least in comparison to the oiled machine of western medicine.

    Our only problem is we do not have the mask of “being covered by insurance” to hide behind.