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Insurance Claim Request - Posted 10/29/18

October 29, 2018 10:39 AM | Shelley Dahle (Administrator)

Dear lovers of acupuncture,

John Frostad has begun the dialogue with the Insurance Commissioner about the practice of insurers denying any EAMP-care outside of acupuncture needling. He needs all Washington practitioners to provide documentation of these practices.

What we need:

1. Practitioner testimonials: Please write a testimonial describing how payment of CPT codes by insurers has affected your ability to deliver care to your patients. Are you having to make patients pay for services that should be paid by the insurer? Are you not offering patients services that they need as part of their care because the insurer will not pay for it? Mention specific insurers if you can. Please keep your complaints specific to non-payment of codes and not issues with pre-authorizations and such.

2. Copies of claims: Send claims that show denials for non-acupuncture needling codes. This includes things like cupping, tuina, and other services, but also necessary re-evaluations and herbal consultations, etc.

a. Please make sure to remove/black out all patient information on the claims before sending them.

b. If possible, please also send an explanation of specifically what it was you billed that was denied. Why was a re-evaluation needed? If a code needs explanation, what was the service it was specifically billed for?

c. Make sure all reason codes are sent also. These usually occur on the last page of the EOBs. The reason it was denied by the insurance is very important.

d. Please send denied claims for as many different insurers as possible. We will be addressing claims handling insurer by insurer.

3. Patient testimonials: Testimonials from your patients are also very important. If patients can complain to the Insurance Commissioner about having to pay for services out of pocket that should have been covered, that would be very helpful. Please make sure their specific insurer and service is included. Make sure they clearly address the letters to the Insurance Commissioner and sign them, so they can be forwarded on.

Send documents and questions to john_frostad@hotmail.com. If you cannot scan and send the documents, you can mail them to 3217 Meridian Ave E, Edgewood WA 98371.

Select the link below to view the text of John Frostad’s presentation to the OIC outlining our concerns as to how our practice scope is being handled.

"Ongoing Issues with Patient Access to EAMP Services."

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The Washington East Asian Medicine Association first began as the Acupuncture Association of Washington over 33 years ago. The organization helped to provide a unified legislative voice for our profession. In fact, our founders were integral in helping establish the legal practice of East Asian Medicine in Washington state. Our all-volunteer Board of Directors currently consists of 7 democratically elected professionals in the field.