Short answer: Aetna generally does not cover acupuncture because it is considered an experimental and investigational treatment for most conditions.
However, some exceptions apply (Based on the information from the Aetna Clinical Policy Bulletin 0135):
- Acupuncture may be covered when used as part of anesthesia for surgical procedures or for post-operative nausea and vomiting.
- Coverage may also depend on state mandates or specific employer-sponsored plans.
It’s essential to review your specific Aetna plan details or contact customer service to confirm coverage for acupuncture in your case.
Conditions for Potential Coverage:
- Acupuncture for Anesthesia: Acupuncture may be covered when used as an adjunct for surgical anesthesia or for managing post-operative nausea and vomiting.
- State-Mandated Coverage: Some states require health insurance providers to include acupuncture coverage, so Aetna may comply with these mandates depending on the location.
- Employer-Sponsored Plans: Some employer-provided plans may include acupuncture as part of their benefits package, even if it is not covered under standard Aetna policies.
Key Exclusions:
- Acupuncture for chronic conditions like pain management, infertility, or other therapeutic uses is typically excluded as it is labeled investigational.
- Additional uses, such as for addiction recovery or mental health treatment, are generally not covered.
Recommendations:
To determine whether your plan covers acupuncture:
- Check Your Plan Details: Review your specific plan’s Summary of Benefits or Evidence of Coverage.
- Contact Aetna Member Services: Call the number on your ID card for personalized information.
- Consider Discounts: If not covered, Aetna offers discounts for acupuncture services through third-party programs like ChooseHealthy.
You can review the full policy details directly here.
