About Provider Networks

Doctors and specialists such as acupuncturists form networks for the purpose of providing employers and insurers qualified and credentialed practitioners with whom they can contract to provide services to their members.

Employers and insurers not only want credentialed practitioners, but those who are willing to comply with managed care requirements so they can standardize the benefits they offer.

Employer groups also control their costs by limiting the number of visits, restricting coverage to certain diagnoses or conditions, and limiting the reimbursement to a specific fee schedule. Many insurers only recognize the effectiveness of acupuncture for certain conditions, such as pain and musculoskeletal conditions, and are thereby only willing to cover those conditions.

Many of the people responsible for defining the use of acupuncture in managed care settings often think of acupuncture as a treatment modality, when in fact, acupuncturists are trained in oriental medicine, which is an entire system of health care which includes traditional chinese medicine (TCM) diagnosis, acupuncture, and chinese herbal medicine. Acupuncturists are trained to treat people based on a holistic system which does not easily translate to simply treating a western medical diagnosis. However, in the managed care setting, that is what we are often expected to do.

Whether to join a provider network involves careful decision-making on our part. Does the network really have a clear understanding of the role of an acupuncturist or naturopathic doctor in a person's health care? Or are they simply satisfying the public's demand for this type of coverage? When we are limited by the managed care network to only treating pain conditions, it is awkward to explain to the patient who may be coming in for digestive problems, for example, that we cannot accept your insurance. It puts us in a difficult situation because in order to treat you holistically, we need to do a comprehensive evaluation of your health and lifestyle. Then we can treat your digestive problems and your back pain and whatever else you have. However, we may only be reimbursed for treating your pain.

We have repeatedly considered which networks to join based on the factors just described. What we won't do is sacrifice the quality of care which we have always offered you in order to belong to all the networks.

A very large network which we have so far chosen not to belong to is American Specialty Health Network (used by Health Net, Blue Cross HMO, Blue Shield HMO and others). We will continue to evaluate networks as they evolve with the goal in mind to best serve you, our patients.