Less Gatekeeping, More Sharing: WCA and the Well
A common question that new patients ask about WCA is, do you take insurance?
The short answer is no (but we can give you a receipt if you want one). Also, you might want to double check what your insurance co-pay is for an acupuncture treatment, because sometimes that turns out to be more than our $20-40 sliding scale fee. You don’t need insurance to get acupuncture at WCA.
The long answer, which includes WHY we don’t bill insurance, is more involved and also more interesting. Long answers are why we have this newsletter!
In making WCA, we wanted to create a community resource that patients could use on their own terms as much as possible -- which is very different from the medical model and its gatekeeping.
Once you bill insurance, you have to provide acupuncture on the insurance company’s terms. Billing insurance vs. not billing insurance creates strikingly different outcomes. Looking at how acupuncture works outside of the medical model, especially outside of the insurance-coverage box, allows us to look at how acupuncture works, period.
In the beginning, we didn’t bill insurance because most of the people we wanted to be able to treat didn’t have insurance that covers acupuncture. And that’s still true, a lot of the time. One of our organizational partners, Care Oregon, describes what WCA offers as low-barrier acupuncture. Requiring insurance remains a barrier to acupuncture for a lot of people.
But what’s really interesting is HOW people use acupuncture when insurance isn’t a factor and they have virtually unlimited access to it.
Back in 2002 when I started the clinic that would become WCA, I’d been an acupuncturist in high-volume public health settings for seven years or so, and one thing I’d learned there is that acupuncture is dose dependent. Another common question about acupuncture is does it work???, and there isn’t a yes/no binary answer for that. You almost always need a certain amount of acupuncture to get a positive effect. Sometimes that amount equals a relatively short course of treatment, like ten treatments in ten weeks, for something acute like a badly sprained ankle. Acupuncture’s amazing at speeding up healing after a physical trauma! However, a single treatment isn’t going to be nearly as effective as a series of treatments.
And when we look at chronic conditions, like diabetes or depression or chronic pain, an effective course of treatment often stretches out over months or even years, because the problem isn’t likely to magically disappear -- it’s something that needs to be managed for the foreseeable future. That’s a LOT of treatments, so insurance coverage for acupuncture often falls short in situations like this. A person might very well have insurance that covers acupuncture, but not ENOUGH acupuncture to be effective for what’s going on with them. Gate-keeping can be a major barrier for people with chronic health conditions, especially if they haven’t been able to get an official diagnosis. Or if their diagnosis doesn’t equate to a problem that their insurance thinks they should receive acupuncture for.
WCA has always had patients who, if they’re lucky enough to have insurance that covers acupuncture, use up their allotted treatments (often twelve or twenty per year) with an acupuncturist who does take their insurance -- and then they come to WCA for the rest of the year. These patients know from experience that regular acupuncture makes a big difference in their quality of life.
In a scenario where people can get as much acupuncture as THEY think they need without having to prove it to an insurance company or some other gatekeeper, acupuncture becomes less of a special occasion. It’s more ordinary, more integrated into people’s lives, and much more useful.
An obvious distinctive element to WCA is the community setting.
Back in 2002 when we first arranged our second-hand recliners in a circle, we had no idea how many people would choose to come to the clinic together. It’s a regular occurrence at WCA for people to arrive in pairs or family groups. It’s not uncommon for people to show up to a scheduled (solo) appointment with a relative in tow. As in, “My grandmother’s visiting me and I thought she’d like to try this, do you have room for a walk-in?” When an acupuncture practice is insurance based, it’s rare that anybody shows up unexpectedly with their grandmother just because they think she might enjoy it! But when you don’t have to worry about whether somebody has the right insurance and a billable diagnosis, acupuncture becomes a resource that people can share with their families and friends. And they do. This is crucial to WCA’s sustainability.
When treatments aren’t rationed by insurance, what we notice is that people use acupuncture whenever they feel like they need help. On one end, that can look like somebody showing up without an appointment, crying in the lobby because they have an agonizing migraine and they’re desperate for relief. (Not uncommon.) On the other end, it can look like somebody realizing that they haven’t slept well for a few nights in a row because they’re stressed out at work and they’d like to address it before it gets any worse (and before it maybe causes a flare up of chronic pain or some other chronic condition.)
When acupuncture treatments aren’t rationed and gate-kept and also aren’t expensive, what we see is that people will use acupuncture to proactively manage their own health. And that’s empowering.
The I-Ching, one of the oldest classical texts in Chinese, is a book of divination based on 64 hexagrams with associated images and meanings. Like many acupuncturists, I was introduced to it in acupuncture school. (Now it even comes in the form of an app.)
Number 48 is “The Well”, which represents the theme of replenishing oneself and others. The text says, “One can change the town, but one cannot change the well. It neither increases nor decreases. They come and go, drawing from the well.” (Source: The Laws of Change: I Ching and the Philosophy of Life, copyright 2013 by Jack Balkin) I think The Well is a good metaphor for the role that community acupuncture can play in our society: a source of nourishment that’s abundant and also held in common; a shared resource that people can draw on as needed.
The Well is what we want WCA to embody. We want acupuncture to be a reliable resource for the community to draw on, as opposed to a special (usually limited) benefit for a few fortunate individuals. It’s fascinating to me that if you set up acupuncture like a well, people will use it like a well. If you take down the barriers to access, people want to share it with each other. This is what our new focus on organizational partnerships is about -- creating more ways to provide acupuncture as a community resource.