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M.D. versus L.Ac.

M.D. vs. L.Ac.

Many people are confused about what to do when an insurance company says that they will pay for acupuncture if it is done by an M.D., but not if it is done by a L.Ac. [i.e., Licensed Acupuncturist]. The California Department of Insurance issued a letter way back in 1985 to clarify this issue.

It states in part: California Insurance Code Section 10176 requires coverage of services rendered by certain qualified health professionals who are licensed under California law, when such services would have been rendered by a physician. Senate Bill No. 2179 amended this Section to include acupuncturists on the list. Therefore it is illegal for an insurer to offer a health insurance policy in California which expressly covers acupuncture when performed by M.D.s, but not when performed by acupuncturists.

If you run into this problem, tell the insurance company over the phone or write them a letter that suggests that they examine California Insurance Code Section 10176. Explain to them that if they pay for acupuncture when it is performed by a physician (M.D.), then they therefore cover acupuncture, and must pay for those services if they are performed by a licensed acupuncturist.

Coverage for acupuncture is also mandated under California Business and Professional Code, Chapter 12, Sections 4925-2979 states, "If a company reimburses a physician for acupuncture, it must reimburse licensed acupuncturist working within their scope of practice;" and under Workers' Compensation and Medi-Cal. Additionally, insurance companies, which sell policies in the State of California, must offer acupuncture coverage to clients. This law does NOT apply to Health Maintenance Organizations [i.e., H.M.O.s] or self-insured plans.