If you underwent acupuncture, moxibustion, massage, or shiatsu with an insurance doctor's approval
Acupuncture, moxibustion, massage, and shiatsu are covered by health insurance benefits (for medical care expenses) if certain conditions are met.
Scope eligible for health insurance coverage
Acupuncture, moxibustion
Benefits for medical care expenses may be provided mainly for the following six conditions, only in chronic cases in which an insurance doctor determines that no other appropriate treatment is available.
- Neuralgia
- Rheumatism
- Cervicobrachial syndrome
- Frozen shoulder syndrome
- Lower-back pain
- Aftereffects of cervical sprain
- * Other conditions may be approved if their primary symptom is chronic pain similar to neuralgia or rheumatism.
- * No benefits will be provided if the patient is simultaneously treated for these conditions at a medical care institution.
Massage, shiatsu
Decisions on whether a condition is eligible for benefits for medical care expenses are not made solely based on the name of the condition. Benefits are provided only if massage is deemed a medical necessity: for example, in cases involving muscular paralysis, muscular atrophy, or articular contracture.
- * Benefits are provided for medical massage intended to improve symptoms: for example, easing muscular paralysis or hemiplegia or increasing the range of joint movement. Treatment for recovery from fatigue, relaxation, or prevention is not covered.
- * No benefits will be provided if the patient is receiving medical massage for the same condition at a medical care institution.
The Society provides benefits by reimbursing the patient.
The Society provides benefits for medical care expenses for acupuncture, moxibustion, massage, and shiatsu by reimbursing the patient. The patient must pay the full amount up front.
After paying the full cost of care at the treatment facility, apply to the Health Insurance Society for reimbursement of medical care expenses, attaching all required documents.
[Flow of reimbursement]
Caution:
Be sure to check the Application Form for Medical Care Expenses to ensure there are no errors in the description of the cause of injury, injured parts of the body, or other aspects.
Letter of approval from an insurance doctor
When applying for payment of medical care expenses, you must attach a letter of approval from an insurance doctor to the Application Form for Medical Care Expenses. Have your condition examined by an insurance doctor and ask him or her to issue a letter of approval.
Another letter of approval is required if the treatment period exceeds six months (one month for manual correction of deformities).
Acupuncture, moxibustion
A patient undergoing acupuncture or moxibustion with a letter of approval from an insurance doctor must be reexamined by and receive another letter of approval from an insurance doctor if the treatment continues past six months.
Massage, shiatsu
A patient undergoing massage or shiatsu with a letter of approval from an insurance doctor must be reexamined by and receive another letter of approval from an insurance doctor if the treatment continues past six months (one month for manual correction of deformities).
Caution:
You might receive an inquiry concerning treatment details, etc.
The Society outsources inspections of the details of Application Forms for Medical Care Expenses submitted by anma, massage, shiatsu, acupuncture, moxibustion, bone-setting, and osteopathic clinics to Taisho Audit Inc. If it is necessary to confirm these details, you might receive either a letter of inquiry or a phone call from Taisho Audit Inc., and we would appreciate your cooperation on this. Please note that such treatment inquiries are conducted based on the regulations stipulated by Articles 59 and 121 of the Health Insurance Act, and?if there is no response or it is found that your insurance does not cover the treatment in question?the bone-setting clinic, osteopathic clinic, or other institution might bill you (i.e. the insured person) for the cost of the treatment.
Please confirm the details of your Application Form for Medical Care Expenses.
Before signing your Application Form for Medical Care Expenses, please be sure to confirm that there are no mistakes in the indicated details, including the cause of the injury and the injury site. In addition, if you receive treatment for which the clinic does not bill the insurer on your behalf, you will have to be reimbursed (which means you pay the full amount in advance), so please apply with the Health Insurance Society for payment of the medical care expenses.