Enrollment Season | Benefits 101: Making the Most of Your Health Plan

Written By Panos Ioannou

By Hiba Fatima CHAA, Billing Coordinator

Don’t Choose A Plan Before Reading This

It's that time of year again: Pumpkin Spice Latte & Enrollment Season. Every month we field dozens of benefit checks from patients. All too often we are the bearers of bad news. Many become frustrated to learn they have a high deductible plan with little or no acupuncture coverage. The good news is during enrollment season, employees get to change their health benefits plan for the upcoming year. Benefits companies bury information in a haystack of jargon most of us don’t have time to read. This post will guide patients in choosing the best plan to make the most of their hard earned benefits.

We’re here to help!

First, let's get into some key terms everyone needs to know. Understanding these terms will help guide you to choose the best plan for your needs.

In-Network: This refers to medical providers who contract with a health benefits company. These providers are generally high-volume practices.

What's the deal? Companies offering benefits will entice providers to sign an agreement with contracted rates. The benefits company will also list the provider in their database. This promises the provider an influx of new patients.

What’s the trade-off?  In-network practices are generally high volume.  Patient visit are often shorter and treatment is less personalized.

Out-of-Network: This refers to medical providers who do not sign a contract with benefits companies. Many health benefits plans cover these providers!

What's the deal?  Since providers do not sign an agreement, they are not bound by contracted rates.  This means they can operate at much lower patient volumes.

What’s the trade off? Out-of-network providers can spend more one-on-one time with each patient.  They also tend to provide a higher quality individualized experience. 

You may be wondering, “what’s the difference? Acupuncture is acupuncture so why not go to an in-network provider?” Here’s a fun analogy we often use to describe the difference. Is all pizza considered equal? Is a $2 slice the same as a gourmet wood-fired pie at a sit-down restaurant?

Deductible: This is the dollar amount claims must reach before the member's benefits kick in. 

Pro tip: Intend on utilizing your hard earned benefits? In our experience, the lowest deductible plans provide the highest level of coverage.


Visit Limit: The number of sessions the insurance will cover in the plan year. 

Pro tip: Visits are “use or lose”. If a plan includes 20 acupuncture visits per year and you only use 5, 15 available visits which could have been covered are gone forever! Unused visits do not roll over into the next plan year. “I love leaving unused visits on the table” said no one ever.

Reset Date: This is the date deductibles and visit limits reset. Most plans reset January 1st.

Pro tip:  Plan your care out according to the reset date.  For those with higher deductibles, it may be beneficial to start care earlier in the plan year. This would allow you to make the most of your hard earned benefits.

Take stock of health and wellness needs. What is most important to you? For example, do you plan on getting acupuncture in the coming year? If so, pick the lowest deductible plan that offers acupuncture coverage. 

PRO TIPS:

  • Benefit details will generally be in the form of a PDF.  Use  control + F to search for a particular benefit. There is usually an “Excluded services” section that contains important information.

  • Need to spend your use-or- lose FSA or HRA? We are registered to accept all spending accounts. 

Action Steps:

  • Choose the lowest deductible plan which includes acupuncture benefits

  • Schedule any unused visits before visit limits reset on January 1st

At Acuworx, our billing team is here to help patients make the most of their benefits.

Panos Ioannou
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