Please please contact Clare at The Billing Service: 360-733-3237.
As of September 2023, I will not be accepting any new insurance patients as the reimbursement rates have not only failed to adjust for the rising cost of living they have actually seen a reduction this year. I sincerely apologize for this new development but it has become cost prohibitive to expand my insurance load.
Existing patients will not be affected.
We do not bill as an out-of-network provider. If your company is not on this list, we will provide you with the documentation you need to be reimbursed by your insurer (this is called a "superbill"). Thank you for your understanding.
Please call the office at 360-734-6463 for our current rates for payments made at the time of service (this applies to services for which no additional billing tasks are required, such as PIP claims). This is a courtesy and not a requirement. Retroactive insurance billing is not available to patients who choose to pay the discounted cash rate at the time of service. Insurance billing rates vary according to the length of your consultation, the medical complexity of your case, the length of your treatment and additional services provided to you beyond acupuncture.
Why did I receive a bill?
If you are using health insurance, a copay is often required at the time of service. If their insurance company determines that they owe deductible, co-insurance, or if there is a non-covered service or amount, a bill will be sent to the patient. Our office does not determine how much you owe: this is determined by the insurance company's contract with the provider and is explained on your EOB (explanation of benefits).
What are copays, deductibles, co-insurance and non-covered services/amounts?
A copay is a set amount that you pay at the time of your treatment, often $15, $20 or $30.
A deductible is a set yearly dollar amount you will owe toward the cost of your medical care before your insurance company will begin to pay for anything except for those treatments that are covered pre-deductible. Consult your plan to determine is one of these.
If you receive $100 of treatment from our office and you have a $250 yearly deductible that has not been met, you will owe our office $100 and that will be applied toward your deductible after the insurance company processes the claims (bills) for your treatments.
Co-insurance is a percentage of your medical services that you owe. It takes the place of a copay.
Non-covered services or amounts are determined by your insurance company. It is the patient's responsibility to keep track of their benefits as, you will be responsible for non-covered services including visits beyond your allowed number.
How was the amount I owe determined?
Your insurance company determines both the coverage (typically called benefits) of your particular insurance plan as well as the allowed payable amounts for acupuncture and massage services. Sirius Medical Billing will send you a bill based on your EOB (explanation of benefits) that is sent by your insurance company to both our office and to you. You will receive your EOB either via US mail or e-mail: it has information explaining what amount you owe, and whether it is co-insurance, deductible, or a non-covered amount.
Please note that some years ago, insurers began requiring acupuncturists to bill in 15-minute increments, so each date of service will have 2-4 codes billed. It doesn't make much sense to me, but I have to play by the rules.
I can't find my EOB or I still don't understand why I owe a balance: what should I do?
If you can't find your EOB from your insurance company it is usually available online. A customer service representative at your insurer may also answer your questions. If you still don't understand the bill, please call Cathy at the number listed above. e the representative explain to you the details of what you owe and why for the date of treatment in question.
I don't agree with the determination of what I owe by my insurance company: what can I do?
Every insurance EOB includes instructions on how to appeal a decision made by your insurance company regarding how your claim was processed. Patients can also appeal directly to the Washington State Office of the Insurance Commissioner by going to: http://www.insurance.wa.gov/