Insurance Billing Out-of-Network

Medicare acupuncture is never covered at private acupuncture clinics.

Unfortunately, since licensed acupuncturists are not able to submit bills to Medicare, providers working in private clinics like ours are never able to accept traditional Medicare plans. To take advantage of your coverage, look for a provider who can submit bills to Medicare, such as a medical doctor practicing acupuncture or an acupuncturist working alongside a medical doctor. 

Acupuncturists have been lobbying the federal government to be activated as medical providers within the Medicare system. Let your legislators know that you support the “Acupuncture for Our Seniors Act” if this issue is important to you.

We only accept Dean Medicare Advantage plans.

We are not able to accept Medicare supplement plans or most Medicare Advantage plans, because they follow traditional Medicare rules (see the information above). However, if you have a Dean Medicare Advantage plan, you can use your coverage at our clinic.

Acupuncture is not covered by Medicaid or Badgercare, but we accept IRIS.

At this time, Wisconsin Medicaid and Wisconsin Badgercare do not cover acupuncture. The Wisconsin Society of Acupuncturists (WISCA) advocates for the expansion of Medicaid and Badgercare to include acupuncture. If you’d like access to acupuncture through Medicaid or Badgercare, reach out to your legislators to let them know. 

We are networked with IRIS – (Include, Respect, I Self-Direct), a long term care program funded by Medicaid for older adults and adults with disabilities in Wisconsin. Call the clinic or submit a comment through our website to request additional information.

We bill Quartz when there is out-of-network coverage or when there is prior authorization for us to do so.

Quartz does not currently contract with acupuncturists outside of UW clinics. However, the process for us to bill Quartz policies that have out-of-network coverage for acupuncture is relatively straightforward. We are also sometimes able to obtain prior authorization for Quartz members to receive our services at our clinic even though they have in-network coverage only. 

Follow the steps below to determine whether you will be able to use your Quartz insurance at our clinic. 

1. Call Quartz to ask whether your policy covers acupuncture and whether you are able to use an out-of-network provider.

2. Quartz Out-Of-Network Coverage: If you have out-of-network coverage for acupuncture, you can use it at our clinic. You will pay out of pocket at the time of service, and your provider will submit a claim for you.

3. Quartz Prior Authorization (PA): If your policy covers acupuncture, but you don’t have out-of-network coverage, we may be able to obtain prior authorization for you to see one of our providers. 

4. Call the clinic or submit a comment through our website to request additional information about how our Quartz billing process works.

We work with Med-Pay policies or supply records upon request

We work with victims of motor vehicle accidents (MVAs) on a regular basis. If you were injured in a car accident and your own auto insurance policy will pay a pre-determined sum for your injuries, we can bill your policy, and you won’t be required to pay for treatments up-front. This type of benefit is called “Med-Pay”, and it is billed like traditional health insurance. Call the clinic or submit a comment through our website to request additional information.

If you do not have Med-Pay, but you will be filing a personal injury claim with the other driver’s insurance company, we can still be of service to you. You will be required to pay out of pocket for your visits, and we will provide medical records upon request. 

We can directly submit bills to workers’ compensation insurance companies, and you will not be required to pay for your visits up-front. We’ll need some information from you in advance, in order to secure payment from the insurance company. Call the clinic or submit a comment through our website to request additional information.