Dawit Assefa, L.Ac, MAOM, FABORM – Acupuncture Fertility & Women's Clinic
In addition to cash, check, or credit card payments at the time of service, I am also a health insurance provider for BLUECROSS BLUESHIELD.
If you have a BLUECROSS BLUESHIELD FEDERAL PLAN, you will have the following Acupuncture coverage (usually after the deductible has been met):
Standard option: 24 visits per calendar year and you pay a 15% copay
Basic option: 10 visits per calendar year and you pay a $30 copay
In order for me to accept your insurance as payment, the following conditions must be met:
1. Call our office so that we can verify benefits for you. The insurance plan must cover acupuncture as a specialist care for the condition(s) you are being seen for, and any deductible must be met. If you require a referral or preauthorization, you must have made those arrangements in advance.
2. You must bring your insurance card and a photo ID to your first appointment.
3. At the time of the first appointment, you must sign the agreement with my office that you will pay any funds the insurance will not pay. This includes any copay due at time of service. Please note that it is possible your specialist copay is different from your regular copay.
If I don’t accept your insurance, it’s possible that you can still be reimbursed for your acupuncture treatment. I can provide you with a receipt that is coded in a way your insurance company may accept it for partial or full reimbursement. Please contact your insurance company to learn their policies about out-of-network acupuncture reimbursements.
|Initial Eval – 10 minutes face to face||99201||$50|
|Initial Eval – 20 minutes face to face||99202||$80|
|Initial Eval – 30 minutes face to face||99203||$125|
|Initial Eval – 45 minutes face to face||99204||$150|
|Follow Up Eval – 5 minutes face to face||99211||$30|
|Follow Up Eval – 10 minutes face to face||99212||$40|
|Follow Up Eval – 15 minutes face to face||99213||$60|
|Follow Up Eval – 25 minutes face to face||99214||$90|
|Acupuncture w/o E Stim||97810||$55|
|Acupuncture addition 15 mins w/o E Stim||97811||$40|
|Acupuncture with E Stim||97813||$75|
|Acupuncture with E Stim additional 15 mins||97814||$60|