“The Curious Case of the $799 Acupuncture Needle.”

I’ve often said that acupuncture is the absolute best value in healthcare. For that, I have no doubt. In a world where a routine doctors physical may now run you over $1000 and diagnostic tests at an ER visit can run into the tens of thousands of dollars, the value of an acupuncture visit at your local acupuncturist is a “no-brainer”. Even a full length recommended course of acupuncture therapy – consisting of a dozen or more visits often runs well under that $1,000 price tag.

I have seen many times, a patient scheduled for an operation… such as a hysterectomy or a new knee replacement, find almost immediate relief with a few sessions of acupuncture. I have (only somewhat jokingly) said many times that the reason insurance companies hate acupuncturists is because we poach their patients and are able to solve a $40,000 surgical medical problem for about $400; That’s (really) bad for business.

While more and more insurance companies are starting to cover acupuncture, they are doing it in a way that simultaneously stifles acceptance; namely, they often cap their reimbursement at a figure so low that most acupuncturists would literally lose money by accepting and billing insurance companies. Put another way, insurance companies are low-balling their reimbursement to the point that it simply does not make financial sense for most acupuncturists to accept insurance. When a “big box” hospital or clinic offers acupuncture, they often bill out to get what they can get and then “eat” the rest as a tax-deductible loss rather than charge the patient the unholy amount that they would normally want to charge. This is because, while they may have the monopoly on advanced medical procedures like a surgical operation or advanced diagnostic test, they simply cannot compete with the prices of the local licensed acupuncturist performing acupuncture.

But…. There is a problem… doctors still love acupuncture…they love recommending it to their patients.  About 25% of my new patients are informally referred to our clinic by their doctor. The rest come from referrals from friends or family.

That is what happened with one patient in particular. This one particular patient had a case of bladder spasms and incontinence (Code R39.81) and was receiving a particular type of therapy at her Physician Assistant’s office at the hospital. The therapy she got was “64566: Posterior Tibial Neurostimulation, Percuteneous Needle Electrode, Single Treatment, Includes Programming”.

Although that sounds pretty fancy, what it means is that she was having her PA provider give her electro-acupuncture on a single point on the leg. A single acupuncture needle was inserted about half way up her inner calf and then had two wires attached from a small battery operated box similar to a “Tens Unit”. The unit would provide a very light electrical current to the needle. She would then sit back, relax and read magazines for 30 minutes before having the needle removed.

She was scheduled for 12 weekly visits at the cost of $799 per visit.

There are so many things about this that haunt and irritate me. I don’t want to sound too cantankerous and jaded, so I’ll keep most of them sour grapes to myself. ;-) 

But the thing that unsettles me the most is that what the hospital did was by-pass the already standard reimbursement rates for acupuncture provided by licensed and qualified acupuncturists (97813: Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes), which would have fetched them about $79 max,  by calling it something else (“neurostimulation”) and giving it a different CPT code number. They then can bill her insurance company $799. Voila! Same procedure but priced at 10 times more.

So instead of charging $79, they are able to charge $799 for that newly invented code number. That….seems….oooh, I don’t know what… illegal maybe? Immoral? Misappropriate? Swindly? Purloin? Nah…. none of those things… it’s fine. Nothing to see here… o_O

Once this particular patient got her first bill in the mail about a month later and found that her insurance would only cover $499 and she was personally financially responsible for $300 per visit, she asked her PA about alternatives; that’s when the patient was told about us and our clinic. If you do the math, she would have ended up with a bill for $3,600 when all was said and done.

So she switched and started coming to us.

In the month that she has been coming to our clinic, she is now almost 100% symptom free, not to mention that several other of her health issues were addressed and corrected. The cost savings? Well, instead of spending $9,588 at the hospital for that  single acupuncture needle, she came to our office and finished her 12 session series for under $500. That’s about a $9,000 savings… for an arguably much better outcome (and more needles  ).

So what do I make of all this? What advice can I share with you? Well, I’m afraid that I really don’t have much for you besides the usual; things like “be interested in what your doctors are charging”. Nag them and ask them what something is going to cost BEFORE they do it (but not during an emergency, please). They won’t know how much you will be charged, because that is the state and nature of today’s medical system. But ask any ways. Nag them and ask them (along with their billing department). Often. About everything. Eventually… maybe… their perturb-ness will filter upstream to their upper management… and maybe… just maybe it will trigger a change in the system.

The other thing you can do is investigate everything else out there you can do for your condition. Become your own advocate and seek out studies at government sites like PubMed. Call around to your local chiropractors and acupuncturists or herbalists or nutritionists and homeopaths, etc. See what they have to say about your condition. Also be sure to ask them who else you should call or what other modality you should investigate; they will be more than happy to suggest many lines of investigation for you. Be your own advocate! Be your own number one champion of your healthcare… rather than rely on one or two professionals. I hate to say it, but no professional will ever be as committed to your health as YOU should be. Of course, even after saying all that;  if time is short and a diagnosis is dire, don’t dally… do what your MD team tells you. Your life may depend on it.

Lastly, stay healthy. You know what to do; focus on perfecting your diet, your sleep quality, your daily routine, your relationships and acquaintances, your physical activity and your purpose in life… get your head on straight and start addressing  all of those childhood traumas…all of these are pillars to good health… the fertile ground you must nurture to allow true, long lasting health and healing.

Peace… Jason