This is a guest post by my classmate and colleague Teresa Lau from http://tlc-medicine.com

In a previous post, I covered the basics of how health insurance coverage works. But there were a lot of details which I left out for simplicity’s sake. As some of you may already have discovered, just because your insurance says acupuncture or other services are covered in your plan, it doesn’t necessarily mean they will actually pay for it. Why? Because there are exceptions, and plenty of them. I’ve highlighted a few of the common ones:

YOUR PLAN COVERS ACUPUNCTURE ONLY FOR CERTAIN CONDITIONS.
Plans may limit coverage of acupuncture to specific health conditions. Typically, low back pain and nausea from pregnancy or chemotherapy are covered by even the most restricted plans. Other plans may be vague and state they they will cover acupuncture when it is considered “medically necessary.” I once came across a plan that would only pay for acupuncture “in lieu of anesthesia,” which, in practical purposes, is pretty useless — unless you are having surgery!

YOUR PLAN LIMITS THE NUMBER OF VISITS PER YEAR.
A plan can place a cap on the number of times you can get acupuncture in a year (typically 20–30). Once you hit that ceiling, you are on your own for the rest of the year. It doesn’t matter if you’ve met your deductible or your out-of-pocket maximum. Also, sometimes they will classify acupuncturists, chiropractors, and other therapy providers in the same category; each time you see any of these providers, it will count toward the running total of visits allowed.

YOUR PLAN HAS A “MAXIMUM BENEFITS” LIMIT.
Instead of limiting the number of visits, as described above, a plan may limit the total dollar amount they will pay for acupuncture services per year. Once the total is reached, you will be paying out-of-pocket for any future care for the remainder of the year.

YOUR PLAN HAS SET AN “ALLOWABLE AMOUNT” FOR EACH SERVICE.
Let’s say your plan covers services from an out-of-network provider. They tell you that you have a coinsurance of 20%, and they will cover 80% of the bill. What they don’t tell you is that they pay 80% of their allowable amount for the particular service. For example, if your provider’s bill is $100, but the plan says their allowable amount is $50, they’ll only pay out 80% of that amount, which is $40. Because the provider is not in your network, he or she can bill you for the balance of $60.
​
As you can see, navigating the world of health insurance can be quite complex. Fortunately, your practitioner should be well versed on these details to ensure you get the most out of your insurance plan. Be sure to discuss with your practitioner your goals and needs. In the ideal case, your practitioner will establish a plan with you and structure your visits to fit within the constraints of your insurance plan.

Teresa Lau is a licensed acupuncturist in the State of California. She completed her Master of Science degree in Traditional Chinese Medicine at the American College of Traditional Chinese Medicine (ACTCM) in San Francisco, CA, as well as a master's degree in Public Health from Harvard School of Public Health.

 This is a guest post by my classmate and colleague Teresa Lau from http://tlc-medicine.com
​
By now, most people in the U.S. have some level of health care coverage. But do you know what you are actually getting in return for paying your monthly premiums each month? Understanding your benefits will help you budget better and minimize unexpected costs when you do seek care. Each health plan has a summary of benefits that stipulate the services that are covered and what those services will cost. Here are some of the common terms you will see in a summary of benefits:

DEDUCTIBLE
This is an amount that can range anywhere from $0 to thousands of dollars. It represents how much of your own money you must spend on healthcare before the health plan benefits kick in for the rest of the calendar year. There are some general exceptions — typically preventive health care services like office visits — which may be covered without having to meet the deductible first.

How it matters
If you have acupuncture benefits, check to see whether the deductible applies. You may end up paying for the full cost of treatment because your deductible hasn’t been met.In such cases, paying with funds from a Flexible Spending Account (FSA) or Health Savings Account (HSA) can help recoup a portion of your costs by way of tax savings. And by the way, if you have money in your FSA, it must be spent before the end of the calendar year, or you lose it. Last December, I had some patients trying to squeeze in appointments so they could spend down their remaining funds. Now is a good time to check your account’s balance and avoid a last-minute scramble.

COPAY/COINSURANCE
​The copay is a fixed amount, typically between $10–$50, which you pay at the time of service, e.g. a doctor’s office visit or prescription drug. Coinsurance is a variable amount that you pay for services. It is calculated by taking a percentage of the plan’s defined allowable amount for the particular service. For example, suppose your coinsurance is 20%. If you get a blood test and and the plan’s allowable amount for that test is $200, then you are responsible for $40 of that bill.

How it matters
Your plan may set different copay and coinsurance rates depending on the type of provider and type of service. Copays are common for acupuncture, but some people do have a coinsurance, usually between 10–40%. My patients with insurance typically pay $40 or less per visit. That’s a good a discount on treatment, so don’t let your benefits go to waste!

OUT-OF-POCKET MAXIMUM
This number represents the maximum amount that you will spend out-of-pocket for the entire year. With some exceptions, once you hit that maximum, you will not have to pay anything more for covered services for the rest of the year. Once January 1 rolls around, this number, like the deductible, is reset back to zero.

How it matters
If you expect to undergo expensive procedures such as surgery or delivery of a baby this year, chances are you will meet your out-of-pocket maximum. That means no more copays or coinsurance payments for the rest of the year! What’s better than discounted acupuncture? Free acupuncture, of course!

PROVIDER NETWORK
Providers who agree to participate in your health plan’s network and accept lower payments for their services. Some plans only will cover services if you see a network provider. Others will allow you to see an out-of-network provider but you may face higher copayment, coinsurance, and/or deductible amounts.

How it matters
A provider may tell you that he or she accepts your insurance, but that doesn’t mean they are in-network with your health plan. If your priority is to keep your costs low, check with your health plan to find an in-network provider. On the other hand, if you have a favorite acupuncturist who’s out-of-network with your health plan, you might still be able to get your treatments covered by the plan.

AND THERE’S MORE…
What I’ve described above are just the basic elements around which most health plan benefits are structured. But keep in mind that there are always plenty of exceptions — which I will discuss in a future post, so stay tuned! In my practice, I always offer to help new patients verify their acupuncture benefits with the health plan before their first appointment. That way, there are no surprises charges to spoil that post-acupuncture bliss.

Teresa Lau is a licensed acupuncturist in the State of California. She completed her Master of Science degree in Traditional Chinese Medicine at the American College of Traditional Chinese Medicine (ACTCM) in San Francisco, CA, as well as a master's degree in Public Health from Harvard School of Public Health. 

Every year we see headlines like " Summertime is 'trauma season' for hospital ERs" and "Emergency room visits rise in summer." From articles like these we learn that visits to the ER tend to increase by 25-30% in the summer. Obviously the warm weather encourages us to spend more time outside doing chores as well as engage in many recreational activities. Soft tissue or joints injuries from trauma such as falls, overuse, or lack of conditioning tend to make up for a majority of the injuries suffered in the summer. 

To understand how acupuncture can help for these injuries, we will review the stages of injury as well as the optimal acupuncture treatment principles.

Stage 1: Swelling, pain, and redness are the key symptoms. The range of motion (ROM) is greatly impaired. During this time using acupuncture points in the ear and distal to the injury we reduce the swelling, heat, and pain. Very often there is a quick change and fast relief.  

Stage 2: There is still swelling and pain but it is less severe. The injured area will have significant bruising (black and blue), weakness, spasm, and secondary tissue damage. Using acupuncture with motion we are able to improve ROM and increase circulation.

Stage 3: During this stage there is usually stiffness and aching. It is not uncommon for some people to not heal completely without further treatment. To prevent this, acupuncture and moxibustion therapy are used to increase blood and fluid circulation as well as tonify channel or tissue deficiencies. Stretching and strengthening exercises are prescribed to regain full strength, function, and ROM.   

The  focus of acupuncture treatment is to speed healing and reduce pain in an acute injury situation while preventing the injury from becoming a chronic problem.

When new patients come into my office the common question is: “How many treatments will it take?”
The answer depends on a few factors some of which we will tackle in this article.

Acupuncture in China is often daily treatment for a course of 10 treatments with about a 2 week break. After this break another course will usually begin if needed. Most of the Chinese research showing the efficacy of acupuncture is based on this daily treatment model. On the other extreme, in this country,  treatments tend to be weekly or bi-weekly and in many cases this is not enough to quickly reduce symptoms.

We have limitations of time, energy, and money so there has to be another way, right?

There is and the word is MOMENTUM.

Riding the Wave
I often give the analogy of pushing a car. In the beginning when it is at rest it is hard to move, but as you build momentum it becomes easier to keep in motion. The big takeaway is acupuncture is a process in which there is a beginning, middle, and end to treatment.

In the beginning by using an optimal frequency of 2-3 treatments a week, the goal is to reduce the intensity of symptoms as well as make sure this improvement holds until the next treatment. The middle is when we build on that progress to the point that the treatment frequency can be reduced to 1-2 treatments per week. The end of treatment is when there is little or no symptoms and we are reducing the frequency of treatment to a maintenance level once every 2-4 weeks. At this stage we are making sure the progress that has been made is stable.

Rough guide for treatment frequency:

• For pain and discomfort that is greater than 5 out 10* = multiple treatments per week
• For pain and discomfort that is less than 5 out 10* = one treatment per week

* 0 = No pain, 10 = Worst possible pain

Example: This may consist of 3 treatments the first week, 2 treatments the second week, then 1 treatment a week for two weeks, and finally 1 treatment every two to three weeks.

Regular Ongoing Acupuncture
Today’s stressful lifestyle and environment can bog us down and make us tired and sick. It has been estimated that 75-90 percent of all visits to primary care physicians are for stress related problems. Regular ongoing acupuncture can be beneficial for relieving these consequences of stress such as headaches, insomnia, digestive disorders, menstrual problems, depressed immune function, weight gain, as well as emotional disorders.

Conclusion
The aim of acupuncture treatment is to tap into the body’s innate ability to heal on its own. Some people respond quicker than others and may require fewer treatments, while some people with conditions of a chronic nature may not respond as quickly and may require more treatments.

Note: This article is for informational use only and should not be a replacement for qualified medical advice.
Information Sourced from:

Kastner, J. (2009). Chinese nutrition therapy: Dietetics in traditional Chinese medicine (TCM) (2nd ed.). Stuttgart: Thieme.

Leggett, D. (1997). Helping ourselves a guide to traditional Chinese medicine. (3rd ed.). Totnes, England: Meridian Press.

Tonify Qi
Carrots (Regulate Qi, clears damp heat)

Tonify Blood
Beets (Regulates Qi)
Chard (Clears heat)
Dandelion Greens (Clears heat, drains damp, clears damp heat)
Kale
Spinach (Nourish Yin, clear heat)
Watercress (Tonify Qi, resolves phlegm, regulates Qi, drains damp)

Regulate Qi
Broccoli (Clears damp heat)
Cabbage (Clears heat)
Radish (Drains damp, resolves phlegm, clears heat)

Clears heat
Bok choy (Drains damp)
Cauliflower
Endive (Clears damp heat)
Grapefruit (Resolves phlegm, regulates Qi)
Kiwi (Astringes Yin)
Lettuce (Clears heat, drains damp, regulates Qi)
Olives (Clears damp heat)

Resolves Phlegm
Kumquats (Regulates Qi, drains damp)
Mandarins (Clears heat, drains damp)

Circulates Blood
Bell pepper (Dispels cold)
Brussel Sprouts
Eggplant (Clears heat)
Leeks (Regulates Qi, dispels cold)
Lemon/Lime (Regulates Qi, clears heat, resolves phlegm)
Onion (Dispels cold, drains damp, resolves phlegm, regulates Qi)
Turnip (Regulates Qi, resolves phlegm, drain damp, clear heat)

Nourish Yin
Avocado (Tonify Blood)
Banana (Clears heat)
Mango (Clears heat, regulates Qi, drains damp)
Orange (Regulates Qi)
Pomegranate (Clears heat)

Tonify Yang
Garlic (Drain damp, resolves phlegm, regulates Qi, dispels wind-cold)
Scallions (Circulates blood, dispels cold, drains damp)

Drains Damp
Chicory
Parsnips

Dispels Cold
Fennel

Note: This article is for informational use only and should not be a replacement for qualified medical advice.

Information Sourced from:
Kastner, J. (2009). Chinese nutrition therapy: Dietetics in traditional Chinese medicine (TCM) (2nd ed.). Stuttgart: Thieme.

Leggett, D. (1997). Helping ourselves a guide to traditional Chinese medicine. (3rd ed.). Totnes, England: Meridian Press.

Tonify Qi
Carrots (Regulate Qi, clears damp heat)
Sweet potatoes (Tonify Blood, nourish Yin)
Winter Squash/Pumpkin (Circulates Blood, dispel cold, drains damp, resolves phlegm)

Tonify Blood
Artichoke (Nourish Yin, regulates Qi, drains damp, clears damp heat)
Beets (Regulates Qi)
Chard (Clears heat)
Kale
Spinach (Nourish Yin, clear heat)

Regulate Qi
Broccoli (Clears damp heat)
Cabbage (Clears heat)
Radish (Drains damp, resolves phlegm, clears heat)

Clears heat
Bok choy (Drains damp)
Burdock (Dispels Wind-heat, drains damp)
Cauliflower
Celery (Regulates Qi)
Endive (Clears damp heat)
Grapefruit (Resolves phlegm, regulates Qi)
Kiwi (Astringes Yin)
Lettuce (Clears heat, drains damp, regulates Qi)
Olives (Clears damp heat)

Resolves Phlegm
Kumquats (Regulates Qi, drains damp)
Mandarins (Clears heat, drains damp)

Circulates Blood
Leeks (Regulates Qi, dispels cold)
Lemon/Lime (Regulates Qi, clears heat, resolves phlegm)
Onion (Dispels cold, drains damp, resolves phlegm, regulates Qi)
Turnip (Regulates Qi, resolves phlegm, drain damp, clear heat)

Nourish Yin
Avocado (Tonify Blood)
Banana (Clears heat)
Orange (Regulates Qi)
Pomegranate (Clears heat)

Tonify Yang
Garlic (Drain damp, resolves phlegm, regulates Qi, dispels wind-cold)
Scallions (Circulates blood, dispels cold, drains damp)

Drains Damp
Chicory
Parsnips

Dispels Cold
Fennel

Thanksgiving, a time for watching football and feasting with family and friends. Unfortunately the feasting part while very delicious can contribute to bloating, distention, and lethargy. Like football, supporting healthy digestion requires a good defense and a good offense.

Defense

1. Do not overeat: We all know that overeating can contribute to weight gain but did you know that it can change our biological clock? Studies on mice have found that overeating can cause them to wake up at night to eat. Physiologically speaking overeating causes the pancreas to produce more insulin to metabolize the excess sugar, however very often it does its job too well by causing low blood sugar (fatigue, nausea, dizziness, depression) which causes you to eat more carbs, thus creating a vicious cycle. Be mindful of what you eat by completely chewing and savoring your food. Also aim to eat until you are 80% full. This article has some great tips for this... 
2. Beware of FODMAPS: These are short chain sugars and related alcohols that are poorly absorbed in the small intestine which can be responsible for bloating and gastrointestinal discomfort. Using this handout from Stanford University, focus on eating foods that are low in FODMAPS and avoid or eat very sparingly those that are not.

Offense

1. Stoke the fire: Drinking a digestive tea after a meal can sooth digestion and relieve bloating. Traditional Medicinals and Yogi Teas have very good digestive teas.
2. Be active: Going for a 15-20 minute walk after your meal can stimulate your digestion and reduce the chance of overindulging at dessert time.

Note: This article is for informational use only and should not be a replacement for qualified medical advice.
Information Sourced from:

Kastner, J. (2009). Chinese nutrition therapy: Dietetics in traditional Chinese medicine (TCM) (2nd ed.). Stuttgart: Thieme.

Leggett, D. (1997). Helping ourselves a guide to traditional Chinese medicine. (3rd ed.). Totnes, England: Meridian Press.

Tonify Qi
Carrots (Regulate Qi, clears damp heat)
Green beans (Tonify Blood)
Pumpkin (Circulates Blood, dispel cold, drains damp, resolves phlegm)
Grapes (Tonify Blood, drain damp)

Tonify Blood
Artichoke (Nourish Yin, regulates Qi, drains damp, clears damp heat)
Beet (Regulates Qi)
Chard (Clears heat)
Kale
Spinach (Nourish Yin, clear heat)

Regulate Qi
Broccoli (Clears damp heat)
Cabbage (Clears heat)
Radish (Drains damp, resolves phlegm, clears heat)

Clear heat
Cauliflower
Celery (Regulates Qi)
Cucumber
Endive (Clears damp heat)
Grapefruit (Resolves phlegm, regulates Qi)
Kiwi (Astringes Yin)
Lettuce (Clears heat, drains damp, regulates Qi)
Zucchini (Tonify Qi)

Resolve phlegm
Mandarins (Clears heat, drains damp)

Circulate Blood
Bell pepper (Dispels cold)
Eggplant (Clears heat)
Leek (Regulates Qi, dispels cold)
Lemon (Regulates Qi, clears heat, resolves phlegm)
Onion (Dispels cold, drains damp, resolves phlegm, regulates Qi)
Turnip (Regulates Qi, resolves phlegm, drain damp, clear heat)

Nourish Yin
Apple (Tonify Qi, clear heat)
Avocado (Tonify Blood)
Banana (Clears heat)
Mango (Clears heat, regulates Qi, drains damp)
Orange (Regulates Qi)
Pear (Clears heat, resolves phlegm)
Peas (Drain damp)
Persimmon (Clears heat, resolves phlegm)
Pomegranate (Clears heat)
Tomato (Clears heat)

Tonify Yang
Garlic (Drain damp, resolves phlegm, regulates Qi, dispels wind-cold)

Note: This article is for informational use only and should not be a replacement for qualified medical advice.

Information Sourced from:
Kastner, J. (2009). Chinese nutrition therapy: Dietetics in traditional Chinese medicine (TCM) (2nd ed.). Stuttgart: Thieme.

Leggett, D. (1997). Helping ourselves a guide to traditional Chinese medicine. (3rd ed.). Totnes, England: Meridian Press.

Tonify Qi
Carrots (Regulate Qi, clears damp heat)
Green beans (Tonify Blood)
Pumpkin (Circulates Blood, dispel cold, drains damp, resolves phlegm)
Fig (Tonify Blood, clear heat)
Grape (Tonify Blood, drain damp)

Tonify Yang
Garlic (Drain damp, resolves phlegm, regulates Qi, dispels wind-cold)

Tonify Blood
Artichoke (Nourish Yin, regulates Qi, drains damp, clears damp heat)
Beet (Regulates Qi)
Chard (Clears heat)
Kale
Spinach (Nourish Yin, clear heat)

Regulate Qi
Broccoli (Clears damp heat)
Cabbage (Clears heat)
Radish (Drains damp, resolves phlegm, clears heat)

Clears heat
Cauliflower
Celery (Regulates Qi)
Cucumber
Endive (Clears damp heat)
Kiwi (Astringes Yin)
Lettuce (Clears heat, drains damp, regulates Qi)
Melon
Zucchini (Tonify Qi)

Circulates Blood
Bell pepper (Dispels cold)
Eggplant (Clears heat)
Leek (Regulates Qi, dispels cold)
Lemon (Regulates Qi, clears heat, resolves phlegm)
Onion (Dispels cold, drains damp, resolves phlegm, regulates Qi)
Turnip (Regulates Qi, resolves phlegm, drain damp, clear heat)

Nourish Yin
Apple (Tonify Qi, clear heat)
Avocado (Tonify Blood)
Banana (Clears heat)
Mango (Clears heat, regulates Qi, drains damp)
Orange (Regulates Qi)
Pear (Clears heat, resolves phlegm)
Peas (Drain damp)
Persimmon (Clears heat, resolves phlegm)
Pomegranate (Clears heat)
Tomato (Clears heat)

You probably notice that I am using a lot more moxa than usual in treatments lately. This is by design since for the next 5wks we are entering a very important time of the year.

To prevent disease in winter, treat in summer

This famous saying in Chinese Medicine means, for diseases which recur every winter, one may attempt to treat them in the summer. To fully understand this concept it is important to think about the nature of summer which is fire and yang while winter is cold and yin. Moxa which is a yang therapy is used to increase the reserves of yang in preparation for the winter months and as a result help prevent illnesses of the winter such as cold and flu.

So how does moxa do this? Scientific research on the actions of moxa show that it strengthens immune function by the release of compounds called histotoxin which increases Helper T cells, natural killer cells, as well as cytokines (INF-v, IL-2mRNA) in the lymph nodes. There is a great deal of research on moxa’s effects as an adjunct to cancer therapy, immune modulation, and increasing the body’s response to stress. Famous Japanese Doctor, Shimetaro Hara who lived to be 109yrs old and practiced medicine until he was 104 attributed his longevity to regular use of moxa.

Regular acupuncture and moxa treatments during the summer and autumn can keep you healthy and energetic during the winter.

Schedule your appointment now!

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How Walking in Nature Changes the Brain
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