Kaiser Insurance Acupuncture Coverage
Acupuncture

Kaiser Insurance: What Conditions are Covered for Acupuncture Treatment?

Kaiser Insurance Acupuncture CoveragePhoto: Tanja Heffner

Kaiser Insurance on Acupuncture

You may have seen that Kaiser has taken over Group Health here in Washington. In their June 5, 2017 “Kaiser Permanente Washington Pre-Authorization Requirements” document, they¬†outline the conditions for which they have determined acupuncture treatment medically necessary. Any non-Medicare patient with Kaiser insurance coverage seeking over eight visits will have to meet the following criteria:

Conditions Covered

  • Arthritis, chronic
  • Dysmenorrhea (i.e. menstrual cramps)
  • Fibromyalgia (must incl. established, documented diagnosis of fibromyalgia)
  • Headaches, chronic
  • Myofascial pain, chronic, e.g.
    • cervicalgia
    • headaches, muscular-tension type
    • lumbago
    • neck and back pain, chronic
    • plantar fasciitis
    • thoracic outlet syndrome (TOS)
  • Nausea/vomiting due to pregnancy or chemotherapy
  • Neuropathic pain, chronic
  • “Other medical¬†medical conditions that have responded to an initial course of acupuncture with expectation of continued functional improvement.”
  • Pain (chronic) due to cancer
  • Pain flares “when acupuncture has provided clinical improvement in the past.”

Other Requirements

The condition has to result in functional limitation, i.e. you’re not able to do what you used to be able to do in your daily living, present daily, and persist beyond the typical time frame for untreated recovery. You’ll also need to document your baseline “measurable functional limitations” and show progress over treatment.

Is this list conclusive?

Of course not. ūüôā It’s subject to change, and is only a guideline. Each plan is different as well in the specifics of coverage and number of visits allowed.

Need Help?

Are you new to Kaiser insurance and would like Melissa to verify your acupuncture benefits prior to treatment? Feel free to reach out; she’d be happy to help you.

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Acupuncture pain relief
Acupuncture

Acupuncture Provides True Pain Relief in Study – NYTimes.com

“In conclusion, we found acupuncture to be superior to both no-acupuncture control and sham acupuncture for the treatment of chronic pain.”

Article

Acupuncture Provides True Pain Relief in Study – NYTimes.com.

Meta-Analysis Cited

Acupuncture for Chronic Pain, Individual Patient Data Meta-analysis

Key Points

  • True acupuncture outperformed sham acupuncture and no-acupuncture controls in the treatment of chronic:
    • back pain
    • neck pain
    • osteoarthritis
    • headache
    • shoulder pain.
  • In studying 29 randomized controlled trials of roughly 1800 patients, researchers concluded that the¬†pain relief found from¬†acupuncture treatment is more than just placebo effect.
  • “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option.”

Not all acupuncture is the same

Aiguille d acupuncture avec regle.dsc02265.untilted+cropped+WB Most people don’t know there are many different types of acupuncture: Traditional Chinese Medicine, Japanese, Korean, 5-Element, Classical, trigger point and more. The technique between these practices can be very, very different. Differences may include:

  • Number of needles:¬†Typically a practitioner will use no more than 8 in a treatment on the conservative end to over 30 in a single session.
  • Size of needles: On the finer end, a practitioner¬†might use a needle¬†.16mm in width, going up to about .30mm (still about a third the width of a sewing needle).
  • Needle retention: Needles can be left in for only¬†a matter of seconds, or¬†up to 45 minutes or longer.
  • Needle placement/location: Some practices will have preferences for distal points, local points, hands-only points, ear-only points, etc. Needle placement doesn’t have to be the same for two practitioners to both get great results from treatment.
  • Qi response: Some practitioners will want a strong “qi response” (think: zinger!) while others will just watch for changes in your breathing.

So, if you think you’ve tried acupuncture, I’d encourage you to consider the breadth of the practice. Don’t give up until you find the right match for you and your condition!

More on Acupuncture and Pain Relief

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Acupuncture

The Leaning Tower of Your Body

Mortons toe

As early as age 14 I was diagnosed with a ligament tear in my knee, and soft cartilage in both knees. Fast forward a few decades and the musculoskeletal issues continued–with ankle sprains, cervical subluxation, kneecap subluxation, and so on. Over the years I saw everyone from orthopedists and physiatrists, to acupuncturists/herbalists, massage therapists, energy workers, chiropractors, a postural therapist, and a podiatrist. So you can imagine my *genuine* surprise when I recently learned about something called Morton’s Syndrome (also known as Morton’s Foot), and realized I had never heard of it.

Let’s take a look:

Morton's Foot in Xray View

You’ll see I’ve drawn a line on these sample x-rays to point to the lengths of what are called the first and second metatarsals (the long bones shown here in the middle of the foot). Morton’s Foot is when the second metatarsal is longer than the first (yes, it’s slightly more complicated than that, but this is the gist.) So, if you take a peep at the image to the left, you’ll see that second bone noticeably pops up over the line; whereas on the right image here, it doesn’t so much. Commonly, but not necessarily, an individual with Morton’s Foot will have a longer second toe than their big toe (as seen in the top image of this post).

Luckily for us, you don’t need an x-ray to see the heads of these long bones! To check your own feet, simply curl your toes downward; for most people this will be enough to allow the heads of the metatarsals to be seen clearly. If you need an extra push, just push from the underside of your feet (just under the second toe) while your toes are curled downward. Which one is longer, your first or your second?

At first, this may not seem like such big news. After all, you can’t even find proper stats on this phenomenon– sources will vary in saying anywhere from 10% to 20% to 25% of the general population share this structural anomaly. But, remember the story of the Princess and the Pea? The body can’t rest until everything is juuuuuuust right. Ideally, and I suppose technically “normally,” our weight is evenly distributed between the heads of the first and fifth metatarsals (this is the end of the bone by the line), and the heel. This creates a ‘tripod’ effect in the foot. But for us Morton’s Foot folks, our second metatarsal bone comes down first, because of its length. (Pea!!)¬†The body then does some circus tricks and comes up with a brand new idea – a twist here, a turn here and voila! The body can put the weight back where it’s supposed to be, on the first and fifth metatarsals. So, picture an ankle that folds down and in (i.e. pronates), and a foot that points out like a duck– a position that forces the big toe’s long bone to come down first. I picture the body like Jenga here, that as we futz with the base, twisting our supports, everything above starts to lose it… slowly, but surely!

From the toes up, you can see the repercussions of our body’s circus act in twisted ankles, knees, hips, back and neck. Morton’s Foot could be the culprit in even fibromyalgia and chronic headaches. The truth is, strong power can come in small packages– and Chinese medicine is totally awesome at treating pain with its tiny needles and many herbs; and in this case, tiny pads that go in your shoes are equally recommended! The cheapest option can be to place pads under the balls of your big toe, affixed to an flat insole in the shoe (and slippers); this rightly makes the first metatarsal the first place of impact. Right now, I’ve just got those round felt pads that go under furniture legs in my shoes to see how it goes. So far – I really notice a difference in my gait and resting posture. (I’m quite excited, actually!!) My next step is to try out these fancy insoles that even accomodate for low and high arches.

How about you? Did you know about this already? (What did you do about it? Did it work?)

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