Acupuncture and Insurance-it's possible, but tricky.

I admit that I have not been as involved in the healthcare debate as I would like to be. People are unsatisfied and I'm not surprised. I'm not going to complain and expect that writing about it will make any changes for the better. My views would probably be simply stated, without much research to validate my arguments. Being new to the profession as a Licensed Acupuncturist, all I know is I've lost money this year to the insurance game, for many reasons. Most people don't know what their plan entails. This is a problem, and I'd like to help you solve it.

One FAQ is "Do you accept insurance?" and this is not directly a yes or no question, with the potential to make one feel foolish if it's followed up with "What kind?" and you stutter to say "I don't know." If you are a patient who wants to find out if it's possible to receive benefits for acupuncture or any alternative healthcare services, a better question would be phrased as "Do you accept [insert insurance company name here]?" You pay hundreds of dollars on your premium yearly so at least try to know who the money is going to. I personally think you should carry your insurance card at all times for these instances, but that's just me.

So, you've asked the doctor if they take your insurance. They say they are In-Network. This is good, but not a done deal. The next step is to call your insurance company to see if you are eligible for this type of benefit. This is the patient's responsibility but if you ask nicely, I'm sure with enough information (Date of birth, ID #, Group #, Customer Service phone # found on the back of the card) the office staff will call for you. The downside is that if you wait until your appointment to check, there's the chance it's not covered or you need an MD's referral and you drove down there for nothing. Frustrating situation #1.

Just because a provider is In-Network and can perform the service does not mean you have verified eligibility. Every insurance plan is different and you get what you pay for. If you have insurance through your employer, they may have certain restrictions that you cannot change, noted in the policy. Many companies don't cover alternative therapies but if the customer calls to inquire about this, they may realize that several affinity programs are available to you and can give you a significant discount (10-25% off the regular rates). If you mention this to a participating In-Network Provider, they are required in their contract with the company to offer this and no paperwork needs to be done.

If you know that you can receive acupuncture benefits, the next step is to ask the insurance company how much your copay is per office visit and acupuncture treatment. These are two different procedures, with two different codes that the office uses on the claim. During the initial intake, a physical exam and health history can take up to 1.5 hours, which is categorized as an office visit, whereas the acupuncture treatment is separate. Even if it occurs on the same day, some insurance companies want you to pay two copays. Frustrating situation #2.

It's also important to know if there is a limit on the number of acupuncture treatments you can receive per calendar year. Sometimes the magic number is 12, which is generally one treatment plan in my office (once a week for three months). Other plans may allow you to get acupuncture as long as you don't go over a certain amount of $ out-of-pocket over the course of the year (i.e. $1000). Some plans only cover specific diagnosis codes like pain or nausea from chemotherapy or pregnancy. If your insurance plan expires, it's always wise to let the office copy the card of the current plan you are using.

If your practitioner is Out-of-Network but you know that your insurance covers the procedure, there is the option to be reimbursed after you have paid for the services. Keep in mind that they most likely will not cover the full amount paid, but it definitely helps. In most cases, your provider can file this claim for you with your signature on file.

Claims may take up to a month to process and in some instances need to be appealed...it's quite inconvenient to stop treatment when you are 1/3 of the way through because of some confusion about paying for the services. As a practitioner, this may cause tension with the patient, which I try to resolve by offering my discount in the meantime. There are times when the patient is committed to getting results and they take advantage of the opportunity. Other times, they sacrifice receiving proper care because they have chosen to stick within the limits of their insurance. I can understand this, but I also find that the suffering is prolonged, which is unfortunate. It's best to prevent this situation by having knowledge about your insurance before starting treatment.

I hope this information has been helpful for you to understand the relationship between the healthcare provider, patient and insurance company. I have encountered many flaws in the system such as patients and providers speaking to different departments with false information, insurance companies unable to find my contract or fee schedule on file, a patient neglecting to check their benefits, and failure to receive a referral from their primary care physician before the office visit. Save yourself time and a headache and inquire about your options. You might think they don't cover alternative medicine but you may be surprised!

From A to B

I've been on a bike more this year than any other, and I've thought a lot about our modes of transportation (thanks, SMG). Since my trip to China, I've stepped back into this side of the world, where everyone is dependent on cars to get around. I wish I could walk outside the door and see people, not vehicles. It's strange not to know your neighbors, and how much emphasis is placed on manners in the first stages of meeting someone. I don't think this is such an issue in Asia. People may have invaded some personal space and stated things I would consider rude during my travels abroad, but there was always unpredictable human interaction to observe. Sometimes it's just too quiet around here and I need to find that excitement myself.

Traffic in China is absolutely ridiculous. It's not gridlock, it's a collective consciousness of flowing harmony. Whereas everyone here stays in their lane, signals when changing lanes and then waves to excuse themselves, drivers in China can sense the presence of others, yielding instead of using aggression (like Tai Chi vs. Kickboxing). This resembles chaos, but it is rare to see accidents, which is hard to say about the Capital Beltway. People are not alert to their surroundings here, much like they are not aware of the dynamics of interdependence. Also, I never witnessed road rage in China.

When I explain the concept of pain to my patients, I often use traffic to illustrate the blockage of qi in our pathways. Maybe there was an accident (trauma), a construction zone (excess), or everyone is going under the speed limit (deficiency). All of these things will affect the flow of qi, the energy that helps to nourish our body, and stimulating certain points will help to unblock the stagnation while relieving pain.

After looking for videos on driving and biking in China, I started feeling a bit carsick. I remember having to close my eyes sitting in the back of a taxi in the beginning, or constantly ringing my bell on my bike to let people know I was approaching. Think about being a pedestrian in this. In most taxis in Hangzhou, a clear divider between driver and passenger is standard. This is to protect the driver so no one can strangle him from behind or attempt to assault him. I never really thought about how dangerous of a job it was for them until I took cabs every day for $1.50/ride. I also had to get used to being rejected a ride (in the pouring rain) if I wasn't going in the same direction as the driver. Eventually I gave up and walked home. If you have some time, watch this video and pay attention to the bike ponchos in the rain, people holding their umbrellas on bike, the pedestrians, the cargo on foot and bicycle, and how there is no such thing as "too close."

Keep it Simple

Each year I donate items to charities or organize a yard sale to simplify my home. Yet somehow, my surroundings don't seem to be less cluttered, and I have stacks of paper I can't bring myself to toss, especially if it's related to my education. If I know they are not necessary for survival, why am I holding onto them?

One of the hardest lessons for a person is learning to let go. Of objects, a loved one, your identity, ego, false notions, an argument, or any idea that is not improving your life. There are different motivations for holding on, and perhaps I can't get rid of the stacks of paper because they symbolize the years and money I spent learning valuable information. Or maybe it will be useful in the next decades so they should follow me wherever I go. But I'm just not ready.

We all have our own methods and pace for coping and dealing with stresses. I find it extremely courageous to admit that one's habit (i.e. smoking) comes from a pathway of self-destruction and a victimized life, to the extent that the possibility of health is beyond reach. In my opinion, this admission is a giant leap, a cry for help, and a moment of honesty. The fear exists that if we put things behind us, we may begin to lose ourselves. The focus remains less about loss and more about moving on, to make room for better chances in our lives, and to become our fullest potential. When patients come to me for addictions, I see in their eyes the readiness to change their lives in a positive way, the desperation in their voice to connect heart and mind, and to relieve the emotional and physical pain they endure. That is why I believe this medicine can work for anyone.

If you want to become whole,

let yourself be partial.

If you want to become straight,

let yourself be crooked.

If you want to become full,

let yourself be empty.

If you want to be reborn,

let yourself die.

If you want to be given everything,

give everything up.

-Tao Te Ching

The Art of Medicine

It wasn't until my third week of the program that I was able to see an acupuncture needle. Here in Hangzhou, the students have concentrations either in acupuncture or herbal medicine (although they learn both in their undergraduate education, a total of 7 years). The first two weeks I sat every morning on an uncomfortable wooden stool in various clinics, listening to the translator dictate herbal dosages and writing them in my notebook. The doctor sat across from her post-graduate assistant and talked with the patient for several minutes in a room full of people waiting to be seen and in the presence of extended family members. I was able to observe the interdependency of families in China and how the illness of one person affects many. At times during my cancer shift, it was the son or daughter of the patient that came in with X-rays, explaining the condition of their loved one in tears. When I visited the gynecology clinic, the doctor would recommend an ultrasound and the patient returned in the same hour with the results, since the hospitals were integrated. I am in awe of this concept.

When I finally got the chance to see acupuncture in China, I was a little intimidated by the quickness of the procedure. It was aggressive. It was effective. People had been coming frequently over the course of months. I have to admit it wasn't my style, but I learned to have courage. When Dr. Wang asked me to cup his patient, it was the first time I would really be participating hands on. With the fire in one hand and the bamboo cup in the other, I tried rapidly to create a vacuum to bring all the blood stasis to the surface. The darker the bruise, the better the treatment. The force was strong enough to draw blood. After receiving Chinese massage (Tuina), I knew these people could handle anything!

At another site, I watched catgut embedding therapy. The doctor injected very fine catgut proteins to be absorbed by the body into acupuncture points for weight loss, fatty liver and irregular menstruation. At the equivalent of $85, a patient could go home with them for 15 days and then come back for more. This therapy was in high demand and the acupuncturist was gifted with needles, also injecting doses of Angelica Sinensis into the necks of patients with cervical spondylosis.

These are only a few moments of what I absorbed during my time in Hangzhou. The variety at each clinic reiterated what I already knew-that TCM is an art to be appreciated and practiced safely without limitations. Every practitioner had their own style and their own relationship with their patients. My opportunities to make the medicine my own are endless.

Living Abroad

I am blogging from BLOG INN. It is situated on the eastern side of the city of Hangzhou, surrounded by fruit stands, steamed buns, tea eggs and doughnut omelettes. There are random noises of construction, chanting, children wailing and men whistling. I am regularly sleeping with earplugs and an eyemask, realizing that city life just aint for me. Living in a hotel and eating out every meal (or substituting meals for junk food/fruit on my shelf) isn't as exciting as I had imagined. At least the food is dirt cheap-$1 fresh Muslim noodle soup-score!



There are always inconveniences to traveling but seeing how drastic my life has changed in China during these few weeks is definitely surprising. I miss my family but I can skype with them on a regular basis, which makes it all so much easier. Having a cousin to visit in Shanghai automatically makes me feel close and comfortable too. I'm putting a lot of energy forth into making the most of each day and my time here. There are the awesome moments when I see a man towing 50 wicker chairs by bicycle as I dodge multiple people crossing my path, people carrying soup to-go in a bag, the whiff of herbs in the air, the sincerity of Hangzhou locals, and the 30m tall golden buddhas at Lingyin Temple.
Shopping has been a challenge. Clothes are made so cheap here, and it shows. Luckily I was able to go to the Silk District today to find a few special items. Most of my Mandarin conversations with the salespeople go something like this:

They say something about me liking what they have in store, would you like to try on?...

Me: I'm sorry, I don't understand. I'm American.
X: What? You don't understand? You look Chinese! (Americans are blonde!)
Me: I'm not Chinese. I'm from Washington. My mom and dad are Vietnamese.
X: Vietnam?! Your eyes are very big! Beautiful.
Me: Thank you :) How much does this cost?
X: (An amount that is absurdly cheap for the garment in American standards)
Me: Too expensive!

and if I really like it, the bargaining begins...


It may not be smart to admit I'm American since they will automatically jack up the price, but I can only pretend I'm deaf for so long. If I'm not into it, there is awkward staring, sizing me up, telling their coworkers...I walk away slowly, they follow closely behind, handing me the most distasteful attire and I question whether I look like I would wear that. I should probably dress up more to go shopping but my theory is if they think I can't afford it I'll get a better price! I find it hilarious that this happens at every shop I set foot inside. I don't bother explaining that I'm not from Washington state, because I'm sure they only know of CA, NY and DC, just like I only knew of Beijing, Shanghai and Hong Kong. I never had a clue that this city of 6 million people was the hometown of TCM and had so much history as the capital of Zhejiang province.

Are you Negative about being Positive?

Today was one of those days where things didn't work out perfectly for me. I thought I had a lot to complain about but then I was inspired by a Wall Street Journal article called "From Attitude to Gratitude...". It reminded me that I can wake up sometimes in disbelief that this is my life. It's nothing glamorous, or deserving of an ounce of envy, but I took a step outside of myself to realize that things are not so bad. I think it helps that I'm in a caring business where people are expected to be honest about the state of their health and environmental dynamics. Listening to others in grief or pain provides me with compassion, sympathy and gratitude, not to mention the reward of attempting to make things better.

In these rough times, my patients are stressing out. They are losing ways to cope and insomnia is on the rise. Whatever state they are in, they desperately want to have hope. Sometimes all we need is a reminder that things will be alright. My coping mechanism is to check my pulse and see if I'm still alive. If I am, then I'll say some sort of mantra or motto like "Each moment is a once in a lifetime opportunity." It's simple and free, even if it sounds cheesy. I don't watch romcoms for nothing!

If you don't feel like persuading yourself to be content, the exercise of writing three good things might be useful to you. When I'm feeling irritable, I think this helps.

1. The ice is melting, which means the odds of me falling on my butt are back to normal.

2. I'm going to do 90 minutes of power yoga tonight, which is guaranteed good feelings.

3. I'm leaving for China in a week! (I have something big to look forward to)

Care to share one thing that makes you smile?

The Company You Keep

                
Have you ever noticed how your life has similar patterns as your peers?  There are studies showing obese people have friends who struggle with the same weight issues (if you're a man!). In my social circle, a lot of people are getting married, and moving on to have children a couple years later.  eHarmony.com stated on a morning show that we look for mates with similar values, ideals, views and interests. One woman had been rejected three times from eHarmony and the only time she passed was after taking Percocet. When asking if it had to do with the "Do you find life meaningless at times" question, she received the explanation that it isn't how you respond to one question-she was a complex thinker, and the tests are not geared for those types of people. (In case you're wondering, she answered that she was a woman which made life meaningless about once a month...) Furthermore, the representative added that this is not to say that people who use dating websites are simple-minded. Perhaps complex minds are just less compatible with others?

I haven't been on these sites myself but do you imagine there are diverse options presented? They say opposites attract. Other people find that similar is better in the long-haul. There are times where I can admire a couple who is thought of as one unit because they are so alike. On the other hand, I think that dating someone with differences may be more rewarding because of the various challenges that arise as lessons in compromise and communication. Would you rather find someone to complement you, or someone who understands? I guess they are not mutually exclusive.

I think I have a wide variety of friends, in all colors, shapes, sizes, ages, educational background and classes. Those are seemingly very superficial things to me. Those who are closest to me can express what's on the inside in terms that I can relate with (like an open mind). I surround myself these days with a lot of family, and I think it identifies me as a person dedicated to long-term growth in my relationships. It's neat how a family can continue to grow and multiply. As for work, the only people I interact with daily are my patients, who on the surface are nothing like me and sometimes don't even speak the same language. But I love that I never know what to expect.  I like different people because I would rather learn from thousands of experiences than the only one I have been given for this journey.