What This Costs, and the One Phone Call That Answers It

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You've been reading about acupuncture. You think this might be the thing. And the question sitting between you and the phone isn't whether it works. It's what it's going to cost you, and whether your insurance does anything at all about it, and you'd rather not call a stranger to talk about money.

That's a reasonable place to be stuck. I practice in Williamsport, so this is written for anybody within driving distance: Muncy, Montoursville, Jersey Shore, Hughesville, Milton, Lewisburg, and out toward Lock Haven.

So here's the plain version. The figures are one click away, and at the foot of this page are two questions that get the insurance half answered in a single phone call.

The figures live in one place, and here's the link

I'll get the awkward part out of the way first.

The current cost of a first visit and of a follow-up is on the booking page, listed next to each appointment type, and that is the only place I keep it. One place, kept current. Nobody should be reading a figure off an article I wrote eight months ago, and that is the whole reason it isn't printed here.

Go and look if the figure is what you came for. Then come back, because the figure is the easy half of your question and the rest of this page is the half nobody answers.

A per-visit figure is the wrong thing to be shopping with

Here's what makes this harder than buying a tire.

When you compare two per-visit figures, you're comparing the price of an hour. What you actually want to know is the price of getting the thing sorted out, and that depends on how many hours it takes, which nobody can tell you honestly before they've met you.

I will not quote you a total in advance. And I would be suspicious of anybody who does. Not because the number is embarrassing. Because it would be a guess dressed up as a quote, and health is several things arriving at once rather than one thing with a repair estimate.

What I will tell you is what the first hour buys, since that part is the same every time.

It's an hour, and most of it is talking. Two intake forms, which ask you different things. The conversation, which is where most of the useful material actually comes from. Your tongue. Your pulse. Your abdomen. The points that are tender when I press them, in places you'd never have thought to mention. And if you bring your blood work, that too, read alongside everything else rather than in a different building by somebody who never sees your tongue.

Eight sources of information in one room, and the job is finding the thread running through them. That's what you're paying for in the first hour. The needles are the cheap part.

That is the hour the figure on the booking page buys. Worth knowing before you look at it rather than after.

The number of visits is a separate question, and I wrote it out already

The honest answer to "how many times do I have to come?" is long enough that it got its own article, and the short version is that I don't prescribe a count and won't invent one.

It's here, and it's worth ten minutes if the total is what's really stopping you.

What "acupuncture is covered" usually leaves out

Now the insurance half, which is where people lose an afternoon.

Plans in Pennsylvania differ by employer, by product and by year. I cannot tell you what yours does. Nobody can except your own plan. What I can do is tell you what the words mean. Then the document stops being a wall.

Deductible. What you pay yourself before the plan pays anything. A benefit can be entirely real and still cost you full price all year, if the deductible hasn't been met.

Visit limit. Some plans that cover acupuncture cover a set number of visits a year rather than all of them. That number is the thing to find. It is rarely on the summary page.

In-network and out-of-network. Whether a practitioner holds a contract with your plan. It changes what gets paid, and sometimes whether anything does.

Prior authorization. Approval the plan wants in advance. If it's required and nobody asked for it, a covered visit can come back unpaid.

Medical necessity. The plan's own test for whether a treatment counts. Two people with the same plan and different diagnoses can get different answers.

Superbill. An itemized receipt you send to your plan yourself, afterwards, to ask for reimbursement. That's the route when a practitioner is out of network, and there's a section on it further down, because the details matter.

None of that is anybody being difficult. It is how plans are built. The words are only confusing until somebody lays them out.

Two questions, one call

Here's the part that saves you the afternoon.

The number on the back of your card gets you a person whose job is to answer this. Ask them exactly two things and write down what they say.

One. Is acupuncture a covered benefit on my plan, and if it is: how many visits a year, is a prior authorization required, have I met my deductible, and is it covered for any diagnosis or only for certain ones? That's one question with five parts and they'll answer all five, because they're reading it off a screen.

That last part is the one that catches people. A plan can cover acupuncture for one diagnosis and not for another, so what you want is which diagnosis codes it's covered under, not only whether the benefit exists. Ask for the codes if they'll give them to you, and write them down.

Two. If I see someone out of network, will you reimburse a superbill, and at what percentage? That second one is the question that decides whether seeing the practitioner you want is affordable.

Ask for a reference number for the call. Get the person's name. If the answer later turns out to be different, that reference number is what makes it fixable.

If the superbill is your route

If I'm out of network for your plan, this is how people actually get money back, and it's worth knowing what a real one looks like before somebody hands you a piece of paper.

A superbill should carry my name and credentials, my NPI number, the clinic name and address, your name and date of birth, the dates you were seen, a description of each service with its procedure code, the diagnosis codes attached to those services, what was charged and what you paid. If a receipt has no codes on it, it isn't a superbill. It's a receipt, and a plan can't process it.

Then the part nobody can tell you in advance, because it differs by plan: how they want it sent. Some have a claim form, some have a portal, some still want paper. So add a third thing to that same phone call. Ask how an out-of-network claim gets submitted, whether there's a form, and where it goes.

Keep a copy of everything you send. A superbill is a request rather than a guarantee, and the reimbursement, if it comes, comes to you rather than to me.

And if you have an HSA or an FSA, that's a third, easier call. Those are administered separately from your medical benefit and the rules aren't the same, so ask the card's administrator rather than the insurer.

When the honest answer is to keep your money

I'd rather say this on my own website than have you work it out afterwards.

If the thing bothering you arrived last week, after something you can name, and it's already heading in the right direction, you don't need to spend anything. Rest it, be patient with it, and let your body finish the job it's clearly doing.

That is narrower than it sounds, and I don't want to talk you out of something I would want to see. Plenty of recent things are worth looking at: a neck that locked up on Tuesday and hasn't turned since, a wrist you landed on, something that arrived fast and is going nowhere. What I'm describing above is the specific case where it's already mending on its own and the only thing it needs is a little more time.

If money is tight, think about it this way. When the choice is between coming here and filling a prescription you rely on, fill the prescription. That is not a close call and I will not pretend it is.

And if what you are describing is new, severe, or getting worse week by week, the first call is not about price. That one is a physician question, and it is today's rather than next month's.

What's actually worth paying for is the other situation. Something that's been going on for a long time, that's been looked at, that nobody has been able to connect to anything, and that you've started to organize your life around. That one is worth real money, because what it needs is an hour spent on the reason rather than on the symptom. It is also the only one where I would tell you so.

What a page can't do

A page can tell you how a cost is built. It can't tell you what yours will be, because that needs somebody looking at you rather than at a keyboard.

That's what the hour is for. Which side is tender and which isn't. What the tongue and the pulse say about what's sitting underneath the thing you came in about. Whether the complaint is the problem or the bill for something else entirely, which is the question I actually care about.

Williamsport, or anywhere in within reach? Then that can be me. Here's what a first visit actually looks like, and the pages on sciatica and back pain and everything else I treat are there if you'd rather read first. Call the clinic at (570) 322-6824 if you want to ask something before you decide anything.

best all ways always

This is general education, not medical advice. It is not a diagnosis and it is not a treatment plan for you. Talk to your own healthcare provider about your own situation. Nothing here describes what any particular insurance plan covers; only your plan can tell you that.

Dr. Jeremy E.R. Reidy, BS, MSOM, AP, DOM is a Licensed Practitioner of Oriental Medicine in Pennsylvania and a licensed Acupuncture Physician and Doctor of Oriental Medicine in Florida. He practices in Williamsport and Lewisburg, treating the whole presentation rather than the complaint somebody walked in with, and reading blood chemistry alongside the tongue and the pulse.

Want more of this? The Regulation Brief is a weekly letter on what your body has been trying to tell you, written the way it gets explained in the treatment room. Subscribe at theregulationbrief.substack.com