Acupuncture Services
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Ancillary
Supplemental coverage for acupuncture services is available to some Health Net members. If members are unsure of their benefit coverage, they should be advised to contact the Health Net Member Services telephone number as listed on their identification (ID) cards.
Health Net members may quality for acupuncture services in one of two ways:
- Enrolling in a medical plan that offers the option to purchase additional supplemental benefit coverage.
- Enrolling in a medical plan that includes supplemental benefit coverage with their monthly plan premium.
Members who have this supplemental coverage obtain acupuncture services through the American Specialty Health Plans, Inc. (ASH Plans) network of participating acupuncturists without a referral from the member's primary care physician (PCP) or participating physician group (PPG).
If a member requests coverage for acupuncture services, and the member qualifies for acupuncture coverage under Health Net's arrangement with ASH Plans, refer the member to the employer, the Health Net Member Services Department or the Health Net Medicare Programs Member Services Department.
Coverage Exclusions and Limitations
The following items and services are limited or excluded under the acupuncture services benefit:
- All auxiliary aids and services, including but not limited to interpreters, transcription services, written materials, telecommunications devices, telephone handset amplifiers, television decoders and telephones compatible with hearing aids
- Lab tests, X-rays and other treatments not documented as medically/clinically necessary as appropriate or classified as experimental or investigational and/or as being in the research stage, as determined in accordance with professionally recognized standards of practice. If American Specialty Health Plans, Inc. (ASH Plans) denies coverage for therapy for a member who has a life-threatening or seriously debilitating condition based on a determination by ASH Plans that the therapy is experimental or investigational, the member may be able to request an external, independent review through the ASH Plans' Member Services Department
- Prescription and over-the-counter drugs
- Durable medical equipment (DME)
- Educational programs, non-medical self-care, self-help training or any self-help physical exercise training or any related diagnostic testing
- Acupuncture services that are considered experimental, investigational or unproven. Services that meet professionally recognized standards of practice in the acupuncture provider community are covered. ASH Plans determine is considered experimental, investigational or unproven
- Charges for hospital confinement and related services
- Charges for anesthesia
- Hypnotherapy, sleep therapy, behavior training and weight programs
- Services provided by acupuncturists who do not contract with ASH Plans, except with regard to emergency acupuncture services or upon referral by ASH Plans
- Only acupuncture services that are listed under the Acupuncture Services topic in the member's Evidence of Coverage (EOC) are covered. Unlisted services, which include, without limitation, services to treat asthma and services to treat any addiction, including treatment for smoking cessation, are not covered
- Services provided by an acupuncturist practicing outside California, except with regard to emergency acupuncture services. Note: No prior authorization is required for emergency acupuncture services. ASH Plans determinations to deny coverage for emergency acupuncture services may be appealed to Health Net
- The diagnostic measuring and recording of body heat variations (thermography)
- Only services that are within the scope of licensure of a licensed acupuncturist in California are covered. Other services, including, without limitation, ear coning and Tui Na, Ear coning, also called ear candling, involves the insertion of one end of a long, flammable cone into the ear canal. The other end is ignited and allowed to burn for several minutes. The ear cone is designed to cause smoke from the burning cone to enter the ear canal to cause the removal of earwax and other materials. Tui Na, also called Oriental Bodywork or Chinese Bodywork Therapy, utilizes the traditional Chinese medical theory of Qi but is taught as a separate but equal field of study in the major traditional Chinese medical colleges and does not constitute acupuncture