Insurance and Acupuncture in Hawaiʻi

A Practical Guide for Patients at Oahu Holistic Medicine (Kailua, Oʻahu)

Many people in Hawaiʻi want acupuncture but aren’t sure how it works with their insurance. This guide explains exactly which insurance situations I can work with, what you need to do before calling, and when it makes more sense to use my cash rates and a superbill.

The goal: less back‑and‑forth on the phone, more time focused on your care.

Summary: How I Work With Insurance

  • In‑network: TriWest (VA Community Care / no TRICARE‑related referrals)

  • Auto accidents (MVA): PIP cases (Geico and others) – case‑by‑case, usually billable

  • All other health plans (HMSA, Kaiser, HMAA, UHA, Medicare, etc.):

    • I am not in‑network

    • You pay my clinic directly

    • I can provide a superbill for you to submit for possible out‑of‑network reimbursement

If insurance is a must for you, please read the section that applies to you before calling or booking so you can do the necessary steps on your side.

1. TriWest / VA Community Care (Military & Veterans)

I am currently credentialed with TriWest for VA Community Care (and related programs). Many veterans can receive acupuncture for pain and musculoskeletal issues with prior authorization.

Step‑by‑step: How to use your TriWest / VA benefits with me

Before you contact my office:

  1. Contact your VA primary care provider (PCP) or case manager.
    Ask for a referral / authorization to see me for acupuncture at:

    Oahu Holistic Medicine, Kailua, HI – Dr. David R. Santander, L.Ac.

  2. Confirm that your referral has been approved through TriWest.
    Ask them to send you written confirmation (letter, portal message, or PDF).

Once you have approval in hand:

Email me:

  1. Your full name and date of birth, A clear photo or PDF of your authorization, Your best phone number and a few preferred days/times

    We will then schedule your first appointment.

    Before your first visit, I must call TriWest and give them: Your first appointment date and time,Clinic details,
    so that your visit is covered under the authorization.

If any of these steps are missing (no referral, no written approval, or no TriWest auth on file), your visit may not be covered and you may be responsible for my full cash rate.

2. Auto Accidents (MVA) & PIP – e.g., Geico

If your pain started after a motor vehicle accident in Hawaiʻi, your Personal Injury Protection (PIP) may cover medically necessary acupuncture. Geico and several other insurers generally pay reliably when the paperwork is done correctly.

Before scheduling an MVA/PIP visit:

See your managing provider
This might be: Your PCP, Your chiropractor, An orthopedic or pain specialist

Ask them to document that acupuncture is recommended as part of your treatment plan.

- Call your PIP adjuster and confirm: Does my PIP policy cover acupuncture?” “How many visits are authorized to start?” “Do you need a prescription or treatment plan from my doctor/chiro?”

Collect the following: Claim number, Adjuster name, phone, and email, Any written approval or prescription for acupuncture

What to send me before your first visit

Please email or text:

  • A clear photo of your auto insurance card (front/back)

  • Your claim number

  • Your adjuster’s contact information

  • Any prescription or approval letter for acupuncture

This upfront work lets me focus on your care while billing flows correctly in the background. If you prefer, you can also choose to pay cash at my clinic rates and I can give you receipts to submit to your PIP yourself.

3. Work Injuries (Workers’ Comp)

For work‑related injuries, your Workers’ Compensation insurer may cover acupuncture when it is part of your approved treatment plan.

Before scheduling:

  1. Confirm authorization:
    Speak with your:

    • Employer HR / safety officer

    • Case manager

    • Adjuster

    Ask: “Is acupuncture authorized for my work injury?”

    Request any written approval or treatment plan that includes acupuncture.

What to bring/send:

  • Claim number

  • Adjuster/case manager contact info

  • Any written approval for acupuncture

Without clear authorization, visits will be billed at my cash rates and you can request reimbursement from Workers’ Comp if allowed under your plan.

4. Other Health Plans in Hawaiʻi (HMSA, Kaiser, HMAA, UHA, Medicare, etc.)

I am not currently in‑network with these plans. Many patients still choose to see me and:

  • Pay cash at the time of service, and

  • Use a superbill to request partial reimbursement from their insurer, if their plan allows out‑of‑network acupuncture.

Because plans and riders vary a lot, it is your responsibility to verify your benefits before your first visit.

How to check your out‑of‑network acupuncture benefits

Call the member services number on your insurance card and ask:

  1. “Do I have out‑of‑network benefits for acupuncture?”

  2. “What conditions are covered?” (pain only, or broader?)

  3. “What is my deductible, and how much of it have I met?”

  4. “What is my copay or coinsurance for out‑of‑network acupuncture?”

  5. “What is my annual visit limit or dollar maximum?”

  6. “Can I submit a superbill from an out‑of‑network acupuncturist for reimbursement?”

Write down the name of the representative and the date of the call.

Using a superbill with me

If your plan allows out‑of‑network reimbursement:

You pay my clinic directly at the time of each visit (cash, card, HSA/FSA).

I provide a superbill with: Diagnosis codes, Treatment codes, Fees paid

  • You submit that superbill to your insurer. Any reimbursement is paid to you, not to me.

5. Cash Rates & When It Makes Sense to Pay Out‑of‑Pocket

Many patients choose to skip insurance entirely and simply pay cash for care that works. This can be especially helpful when:

  • Your plan only covers acupuncture for very narrow conditions (e.g., chronic low back pain only).

  • The deductible is so high that you’d be paying out‑of‑pocket anyway.

  • You want freedom to work on stress, sleep, digestion, fatigue, or more complex patterns that insurance doesn’t always recognize.

Current clinic rates (Kailua office)

  • First visit (initial evaluation + treatment, 75 minutes): $150

  • Follow‑up visit (60 minutes): $135

I also offer a 3‑visit series for focused work on a main issue:

  • 3‑Visit Deep Relief Series: $399 total

    • 3 visits over 3–4 weeks

    • Evaluation, treatment, and home plan

    • Herbs, if used, are billed separately

You can always start with a single visit, and if we decide a 3‑visit series makes sense, we can convert it at or after the first treatment.

6. How to Get Ready Before You Call or Book

To keep admin time low and get you on the table faster, please do this before reaching out:

If you want to use insurance, PIP, or Workers’ Comp:

  1. Call your plan/adjuster and confirm benefits using the questions above. Get any referral, prescription, or authorization in writing.

  2. Text or email me: Clear photos of the front and back of your insurance card, Any authorization or referral letters, Your claim number and adjuster contact (for PIP/WC)

  3. If you prefer cash‑pay:

    • You don’t need to talk to your insurer first.

    • Just reach out and let me know:

      • What you’d like help with (1–2 sentences)

      • Whether you prefer a single first visit or the 3‑visit series

7. Still Unsure What Applies to You?

If you’re overwhelmed (totally understandable), you can email me a brief note with:

  • Your main concern (e.g., “neck pain after a car accident,” “chronic insomnia,” “stress and migraines”)

  • How you hope to pay (TriWest, PIP, HMSA, cash, etc.)

I’ll answer honestly whether:

  • We can likely bill through your coverage, or

  • It would be simpler and more predictable to use my cash rates and superbills.

The cleaner we get this part up front, the more energy we both have for what matters: getting you out of pain, sleeping better, and feeling like yourself again.