Acupuncture paid at physician rate sustained on appeal

Okslen Acupuncture P.C. v Travco Ins. Co., 2014 NY Slip Op 51209(U)(App. Term 1st Dept. 2014):

“The affidavits submitted by defendant in support of its motion for summary judgment established prima facie that defendant timely and properly denied plaintiff’s no-fault claim to the extent plaintiff sought reimbursement in an amount greater than that authorized by the workers’ compensation fee schedule applicable to physicians who render acupuncture services (see Akita Med. Acupuncture, P.C. v Clarendon Ins. Co., 41 Misc 3d 134[A], 2013 NY Slip Op 51860[U][App Term, 1st Dept 2013]; Great Wall Acupuncture v Geico Gen. Ins. Co., 16 Misc 3d 23 [2007]). In opposition, plaintiff failed to raise a triable issue as to the efficacy of defendant’s mailing of the claim denial or the calculation of the fee. With respect to the latter, the affirmation submitted by plaintiff’s counsel did not address the nature of the acupuncture services rendered to plaintiff’s assignor, much less demonstrate that those services were not “similar” to acupuncture services generally provided by physicians, so as to exempt plaintiff from the reach of the physicians’ workers’ compensation fee schedule

What is interesting is that this is now the second time this Court has left the door open for a medical provider – on a proper record – to obtain a fee for acupuncture in excess of that established in the chiropractor fee schedule.  Nobody ha succeeded as of yet.


3 Responses to “Acupuncture paid at physician rate sustained on appeal”

  • Greg:

    Good analysis Jason. I like this decision. If I was practicing in the first department, I would use this case, along with excerpts from the Hon. Rios, J. concurring in part and dissenting in part in Great Wall Acupuncture v Geico Gen. Ins. Co., 16 Misc 3d 23 [2007])….While it is true that workers’ compensation fee schedules have been established for acupuncture services performed by a chiropractor, the record is silent as to whether the subject billing refers to treatment which is usually rendered by a chiropractor within the scope of his or her chiropractic license (see Education Law § 6551), or whether the billed services are for treatment for which a license as an acupuncturist is needed (see Education Law § 8214), in which event, the procedures performed by plaintiff’s acupuncturist would be sufficiently dissimilar from those rendered by a chiropractor that the fee schedules established for chiropractors should not be invoked.

  • Anonymous:

    No Affidavit from an acupuncturist would be sufficient. It is well settled that a licenesed acupuncturist, not matter who or she is and how great their services may be, is only entitled to the chiropractic rate. This is no longer an issue and it is a waste of time to try and make it an issue.

  • Wang Chung:

    This is ahhhh …. Wang Chung.

    In Chinwa we give as much Acpwtunture as needed. All day constant if nweeded.

    Amerikwa say no Acupwunture … insurance compwany want you take Oxycontin for pwain becwause cheaper. So do cworts and department insurance who are subsidwary of insurwance compwanies.

    That why Amerikwa so disgusting. All drug addicts. Number on rate of incarcerwation in entire plawnet in #s and %. 25% of people in jail in world in Amerikwan jails.

    Amerikwa you suck.

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