Why I am not a preferred provider on your health plan.

My personal ethics keep me on the outside of the major health care provider system.

However, it is very important to me that my position does not prevent anyone who wishes to see me from doing so. I am committed to providing affordable care to the full extent that I am able. Learn details on how we can still work together, with or without insurance coverage.

Why I am not a preferred provider on your health plan

If I were to sign a contract to join a provider list:

There would be limits imposed on what conditions I would be allowed to treat.
Generally, only pain conditions are covered for acupuncture. This shows ignorance and disrespect for the holistic and widespread application of acupuncture and invariably leads to practitioners lying on their patient records in order to be reimbursed. All non-pain complaints are left out of the notes. This is a sticky situation, with all options a bit distasteful.

I would be prohibited from doing direct moxa.
Moxa is a technique of major importance in my practice, as well as an extremely effective home self-care technique.

Many people would read and have access to your file.Patient/practitioner confidentiality may be a vanishing concept, but I believe that what you tell me about your physical/emotional/life circumstances is nobody else’s business unless you wish it to be. In addition, as a preferred provider, my place of practice could be entered and inspected (including patient files) at any time.

I object to the concept of “preferred provider.”
The Washington State Board of Health does an excellent job of maintaining high standards for all licensed acupuncturists in this state. HMOs “prefer” the practitioners who agree to the above conditions, subtly conferring higher status and regard on practitioners whose only distinction is that they have agreed to work within insurance companies’ limitations.

There are hours and hours of required, uncompensated paperwork for providers.It is remarkable how much time my fellow practitioners spend on the phone, pleading with insurers to pay up on their bills. I’d rather spend that time helping clients.

I believe that the entire concept of health insurance for (immense) profit is unethical.

An inside look at how health insurers think

To give you an actual example of what the health insurance world-view is like, here is a quote from a July 2008 American Acupuncture Council announcement to entice acupuncturists to take a seminar on insurance billing:

Quick Tip of The Week
Billing timed services: When billing physical medicine timed services the chart notes must indicate the time the service was performed. Time is what the carrier is paying for and will review for time should the file be audited. Note 8 minutes is the minimum time for any 15 minute service but multiple services on the same visit are cumulative. Therefore to get paid 1 unit of two different services you must spend a cumulative time of at least 23 minutes (1 unit = 15 minutes and 2 units must be 15+8 or a minimum of 23 minutes spent cumulatively). If only 8 minutes were spent on each service the total time is only 16 minutes and qualifies for only 1 unit. However the more expensive of the two may be billed.

Is this what you want your practitioner thinking about while deciding your treatment? Someday this country will have sane, single-payer health care for all.

Lesli Dalaba, L.Ac. Treetop Acupuncture, Seattle, WA WA State License No.150

Email or call 206.323.3277 to make an appointment.