INSURANCE PATIENTS

 The Qi Spot Lounge

The Qi Spot Lounge

Please Note: We do not take OHP, Medicare or Medicaid Programs yet.

We check insurance on Tuesday and Fridays!!

If you need to check your insurance urgently, here is what you need:

What you should have ready when you call your insurance company

  • Your Name as it appears on their documents
  • Your subscriber ID / Member Record Number (Kaiser or CHP) / Social Security Number
  • Your Date of Birth
  • They may need other information to verify who you are.

Call the number on the back of your card to talk to a representative. Most insurance companies also provide information on their website. You may need to log in to access personal plan information. Sometimes Acupuncture falls under "Complementary Care" benefits

What do you want to find out?

1. Do I have Acupuncture benefits?

2. Do I have to meet a deductible?

3. How many visits or $ amount per year?

4. How much do I pay per visit?

That should be it.

 

Questions in Detail

1. When you call your insurance company, ask for "Medical - benefits and eligibility".

2. When talking to a representative,

  • ask for "In-Network benefits" if you have the following insurance plans: Regence, BlueCross BlueShield, Regence Federal Employee Program, Kaiser, Complementary Healthcare Plan (works with Kaiser), Providence, HealthNet, American Specialty Health Systems (Works with Providence and HealthNet), Moda Health (previously ODS), Aetna, Cigna and Cigna GreatWest, Lifewise and Pacific Source.
  • or ask for "out-of-network benefits", if you have the following insurance plans: UMR (Legacy)
  • Motor Vehicle Accident Insurance, Workman's compensation - call or email us. You are already covered for Acupuncture. No referral needed. 
  • Insurance we DO NOT take:
    • Oregon Health Plan: Acupuncture under OHP only covers Drug dependency or pregnancy for now. Things change so check with OHP. Call them to find an In-Network Provider. They are very helpful people.
    • Medicare: For now, Acupuncture is not covered under medicare programs, but that may change soon.
  • f you do not see your Health Insurance company mentioned above, please ask them for both In-Network and Out-of-Network benefits.

3. Please ask for the following on your benefits

  • Do I have Acupuncture benefits on my plan? If yes, then you can ask the following questions
  • If yes: Do I have to meet a deductible before my insurance company starts to pay for my Acupuncture visits? If yes, how much. (Some insurance companies like Regence waive the deductible)

    • If you have a very high deductible, then ask: Do I have a Health Savings Account or something comparable to help me with my high deductible. (Companies like Intel may have high deductible plans, but their employees and families have Health Savings Accounts or flexible spending accounts as an additional benefit which help pay for Acupuncture visits or copays before they are able to meet the deductible).

    • If yes; can the provider bill the insurance plan directly or do I have a debit card given to me for this kind of a situation?

  • How many visits do I have per year or how much in (US$) dollars is allocated to the benefit?

  • How much do I pay per visit to the provider?

  • For Kaiser patients Only - All Kaiser patients have Acupuncture benefits but they fall under to 2 plan types:

    • Self-Referral – Kaiser works with Complementary Health Plan to give patients Acupuncture benefits with a dollar maximum allowance per year, no referral needed, no deductible to meet.

    • Patient Needs a referral from their Primary Care Provider or a specialist. These are given especially when a patient has a consistent issue that is not being resolved with western medicine like drugs, or therapy. Most situations are pain related. A patient has to see their doctor to assess the situation, but if you recently saw your doctor for the issue, you can call or email them and ask if they can give you a referral? Every situation is different so please consult with your PCP first. Please note: Some Kaiser patients may need to meet a deductible first even if they are given a referral. 

4. Provider's Name or Clinic: Wade McCulloch or The Qi Spot

 

Insurance Disclaimer: 

“A quote of benefits and/or authorization does not guarantee payment or verify 
eligibility. Payment of benefits are subject to all terms, conditions, limitations, 
and exclusions of the member’s contract at time of service.”

Insurance Liability for Payment: 

Your health insurance company will only pay for services that it determines to 
be “reasonable and necessary.”  If your health insurance company determines that a particular service is not 
reasonable and necessary, or that a particular service is not covered under 
your plan, your insurer will deny payment for that service. 

Beneficiary Agreement: 

I understand that my health insurance company may deny payment for some  
services unknown to my provider. If my health insurance 
company denies payment, I agree to be personally and fully responsible for 
payment. I also understand that if my health insurance company does make 
payment for services, I will be responsible for any co-payment, deductible, or 
coinsurance that applies.