As of February 18, 2022, Alex Leddy Acupuncture will be out-of-network with Cigna. If you are employed by Aspen Valley Hospital, Aspen Ski Co, the City of Aspen, or Pitkin County, please see the document below to check your out-of-network benefits.

• Accepted Insurance:
  • Currently, Alex Leddy Acupuncture is accepting Cigna Health Insurance (however I am an out-of-network provider) and United Healthcare. If you do not know whether or not your insurance plan covers acupuncture services, please call your health care representative for information about your specific plan. 
  • I DO NOT verify benefits at this time. Many plans are deductible dependent and have many nuances that cannot be ascertained prior to receiving an official EOB (explanation of benefits), so I ask for payment at the time of service for ALL patients EXCEPT those with Cigna who work specifically for Aspen Valley Hospital. Thank you for understanding.
  • To visit these health insurance websites, click the links below:
    • Cigna (out-of network benefits only)
    • United Healthcare

•  HMO's, Medicare & Medicaid:
  • Unfortunately, neither HMO’s nor Medicaid covers acupuncture services at this time.
  • Many Medicare plans do have acupuncture coverage, however, in order for acupuncture to be covered, services have to be provided by an MD, RN, or PA. For a licensed acupuncturist to be covered under Medicare, they must be under the supervision of one of those 3 types of providers. 
  • By switching from an HMO to PPO insurance, you are able to see any doctor that you choose and you are not limited to needing referrals.

• Other options:
  • If you have insurance other than Cigna or United Healthcare and would like to submit a claim to your insurance company for acupuncture services, I am happy to give you a Superbill documenting your treatments. I ask, however, that you pay for your services in full at the time of treatment.

• Does my insurance company cover acupuncture?
  • It is not which insurance company will or will not cover acupuncture therapy, it is your specific policy that determines if you have acupuncture coverage or not.
• • Insurance companies that have accepted acupuncture include:
    • Aetna
    • Auto Insurance
    • Bluecross & Blueshield
    • Cigna
    • Humana
    • United Health Care
• How does insurance coverage for acupuncture work?

  • Most acupuncturists develop their fees by figuring out how much they want to charge for a visit and including everything they do in that fee. For example, an acupuncturist may charge $150 (this number is not based on anything nor is it a suggestion of any kind) for a visit and provide acupuncture, heat packs on the back, a heat lamp on the feet, and massage with liniment for a few minutes after the acupuncture. This will not work for insurance billing.

   

  • Insurance billing requires a separate code (Current Procedural Terminology codes, or CPT codes) for each procedure or service performed. Each of the services described in the previous paragraph has a separate code. And each is individually reimbursable. This has pros and cons. It may mean that you can get more money than the $60 by listing each service separately. Of course, insurance may not pay an acupuncturist for each of these services. Or insurance companies may deny some of them but not all of them, meaning more paperwork hassles. But many will pay for each and every one. In California’s workers compensation system, the reimbursement for the treatment described in the previous paragraph would be around $132. Anyway you look at it, improper coding, including packaged services, is unethical, possibly illegal, and can have ramifications.

   

  • A proper fee schedule will have individual codes and how much is charged for each of these codes. Charting should include individual services and their corresponding charges. What the charges are for each code is completely up to the individual practitioner. These charges can be influenced by competition, geographic location, and other business factors.

   
  • Legally, patients may request a copy of a practioner's fee schedule, and the practitioner must provide it. Discounts can be offered for "Time of Service," or TOS, payments, which allows practitioners to charge less for "self-pay" patients, or patients paying at the time of their appointment, while legally billing insurance companies more for the same services.