The Basics > Insurance > 2) Medicare 

This page includes the following sections:
  1. General Info
  2. Medicare Denial Letter - Explained
  3. Optional Cover Letter Prose for Medicare Denial Letter

1) General Info

  • Acupuncture is NOT a covered Benefit -- Unfortunately, Medicare does NOT currently cover any Acupuncture Services, BUT if you have a Secondary Health Insurance that includes Acupuncture coverage,  you can get credit/reimbursement for our services.   It's a little tricky making this happen the first time you do it, but once you understand the rules, it's "better".

  • ​Nutritional Consulting and Nutritional, Herbal and Homeopathic products are NOT a covered Benefit -- Unfortunately, Medicare does NOT cover any services related to Nutritional Consulting Services nor the purchase of Nutritional, Herbal or Homeopathic products.   No secondary insurance providers cover these either.  If you have a personally managed Health Savings Account or similar, these services and products may qualify for tax free self-managed reimbursement. 
    ​
  • Secondary Insurance -- if you have secondary insurance that covers Acupuncture, you can use a "Super Bill" (a receipt for services from us) to get a denial letter from Medicare, and then you can submit the denial letter and a copy of the Super Bill to your secondary carrier for credit/reimbursement.  We do not process Secondary Insurance claims for any of our patients

2) The Medicare Denial Letter - Explained

If you have Secondary Health Insurance and if it covers Acupuncture you can get reimbursement/credit for your treatments.  

But here's the squirrely, outdated, ritualistic part...
  1. All Health Insurance Company Customer Service Agents and all Medicare Customer Support Personnel know Acupuncture is not a Medicare covered benefit.  It's common knowledge across all industries.
  2. As such, you "should be able to" submit a receipt for services (aka a "Super Bill") to your Secondary Insurance Provider from the get go and be on your way with credit/reimbursement processing, right?
  3. UNFORTUNATELY it's not quite that easy.  All Secondary Insurance Providers want to see a "Medicare Denial Letter" with each claim you submit for Acupuncture.

If you are shaking your head right now in disgust, that is somewhat understandable and in fact an expected response to this simple reality.   
  • Can you imagine taking aluminium cans to a recycling center and being asked to show you were the proper owner before dropping them off?  Can you imagine being required to show your library card in person to return a library book?
  • To think that in this day and age a ritualistic formality like this Medicare Denial Letter should be required for this specific situation as it relates to Acupuncture is incredibly frustrating,  but it's still a part of some archaic commerce, and as such we are going to try to make this as easy as possible for you.
  • IMPORTANT NOTE THAT MAKES THIS A LITTLE BETTER:  You do not have to get a new Medicare Denial Letter  with each Acupuncture visit.  In  theory, the first letter you get from Medicare should last you a lifetime, but in reality you may need to get a new one each year or every few years (or just do a nice job whiting out the date and copying the same letter as needed).
​
To try to simplify this for you as much as possible, below we have included:
  1. Optional Cover Letter Prose -- If you want to include in a cover letter with your Medicare Submission this is the simplest text we could think of to convey your request.  In theory, this cover letter should not be needed.
  2. Completed 1 page example of Medicare Patients Request for Medical Repayment  -- We've filled out the one page form you need to fill out for Medicare to show you how simple the request is.
  3. A Super Bill Example -- We've included an example of what our Super Bill looks like.  These come in various forms.  Each Practitioner may have a different form, and some practitioners may provide you with something referred to as  a "HICFA" form.  They all should work.​  THIS MUST BE INCLUDED WITH YOUR SUBMISSION TO MEDICARE.
  4. Blank Medicare Request for Medical Repayment Form with Medicare submission address info for all States -- We've provide you with a blank copy of the medicare form you need to fill out.  This downloadable document also includes the mailing addresses for the privatized Medicare billing providers which you will submit to depending on your geographic location (not our geographic location).​

3) Optional Cover Letter Prose for Medicare Denial Letter

1/11/2017

{Medicare Reimbursement Processing Company Name from list of providers by state}
PO Box XXX
CityX,  StateY  99999

Dear Sir/Madam:

I’ve received Acupuncture Services.  I realize Medicare does not cover those but I need a Medicare Denial Letter to submit this claim to my secondary insurance carrier.

I’ve enclosed:
  • A “Patient’s Request for Medical Payment” form related to this service
  • A copy of the “SuperBill” that has been provided to me by my service provider.

Please return a Medicare Denial Letter as appropriate for this situation  to the address I’ve provided on my “Patient’s Request for Medical Payment Form” so I can then proceed with this reimbursement process with my Secondary Insurance Provider.

Regards

John Doe

2) Completed 1 page example of Medicare Patients Request for Medical Repayment 

3) A Super Bill Example

4) Blank Medicare Request for Medical Repayment Form (with submission address info)