Provider may Charge Separately for Evaluation and Treatment on Same Day
Li Chen LAC and Geico Insurance Company
AAA Case No. 412009044658 (Marilyn Felenstein, awarded February 18, 2010)
At dispute in this case? A mere $32.36.
The applicant, an acupuncturist, submitted a claim for both an initial acupuncture evaluation and an acupuncture session on the same day. The respondent paid a reduced amount, presumably on the grounds that only one of the two charges was warranted.
The arbitrator addressed the question of what fee should be paid to licensed acupuncturists, citing Great Wall Acupuncture a/a/o Miguel Zayas v. Geico, 842 NYS2d 131 (App Term, 2d & 11th Jud Dists 2007) where the court held that in the absence of a separate fee schedule for health services rendered by license acupuncturist, the proper fee schedule to be applied is that which is applicable to services provided for chiropractors, not doctors, who perform acupuncture, as chiropractors and acupuncturists must obtain similar licensing requirements to perform acupuncture.
Roy Mura
Bethany Mazur
Scott Mancuso
