Going Rogue

My dear patients and prospective patients, I have made the difficult decision to stop being in network with insurance providers. There are so many reasons why and it was something I’ve been considering for quite some time, but COVID-19 has tipped the scales for me. Many of you were not meeting your deductibles prior to COVID-19 and since the pandemic, even fewer of you are able to access your insurance benefits because of unmet deductibles. Additionally, billing insurance was literally costing me often more than I was bringing in from many plans. I was having to focus so much time on trying navigate each individual plan and their unique and complex systems. I really want to give my time to patient care and community work. This will allow me to do so.

I am still able to accept HSA cards and can provide a “Superbill” for patients who would like to submit their out of pocket expenses to insurance. Just ask!

I am instituting a sliding scale in lieu of flat rates now. My normal cash rate still applies, $120 for new patients and $90 for returning patients. I am now able to easily accommodate changes in your financial situations though! Which I think is especially important right now. So my sliding scale is an honor system and you can pay what you are able, no questions asked. Most of may patients generally insist on the value of treatment and I have no doubt that 99% of folx will truly pay what they can. This is in alignment with how I believe healthcare should operate as well. I do not believe that your health should be for-profit.

All of this is possible because I am not a sole income earner in my household and I acknowledge that privilege. Many providers are unable to do this. Our education left most of us with very high student loans, often on a level with traditional medical school. While our operating costs are relatively low, COVID-19 has increased expenses for all healthcare providers. PPE, air filtration systems, higher volumes/inflated costs of cleaning supplies (often at higher, hospital grades) and lower patient volumes etc. have had a severe impact on the healthcare field, particularly independent family-style practices. I share this with you as I believe transparency in healthcare is key to increasing community-based, equity centered care. And with this new model for my practice, I will rely heavily on personal referrals and word of mouth to continue building my practice. Your referrals are greatly appreciated and the highest measure of my success.

If you have ANY questions about this, please do not hesitate to ask!

Maria

Fall Updates

As my time filling in for another acupuncturist across town is coming to an end, I have a chance to make a few updates! Fall is here with changing leaves, rain (finally!), stone fruits, and pumpkin spice everything back. If we look to nature, fall is a time of letting go (think leaves falling from trees or ripe fruit dropping from the vine). It’s the proper time for some things to some to an end and for reflection so new ideas can hatch in the spring. Read on to learn more or just skim the bold for the highlights.

In this update:

• Insurance Updates

• Cupping Appointments

• Shiatsu Self-Massage Video

• Well Community Fund

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Cupping Available

A number of patients have asked me about cupping recently. If you are familiar with cupping, I have cupping only appointments available for 30 minutes at $45. If you want to add on a cupping session to your acupuncture appointment, you can now book a 90 min session and for $120 only (rather than $135) for cash patients. For insurance patients, I can offer your copay plus $30 if you book the two together

If you are new to cupping and unsure what that even is, here’s a link to a nice description from Pacific College of Oriental Medicine or ask me for a demo at your next appointment!

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Extend the Effects of Your Treatment!

I’ve put together a free video on how to do a shiatsu-based self-massage that may help extend the effects of your acupuncture treatment, assist in times of stress or as just a nice self-care activity. Shiatsu massage is a Japanese acupuncture channel based massage that feels amazing! I trained for a year with Jim Cleaver, LAc on short-form shiatsu. While taking this class, we also learned a wonderful form of self-care self-massage based on shiatsu.

I’m excited to share this practice with you! Rather than take up valuable treatment time with each of you, I’ve created a how-to video. This massage can take as little or as long as you’ve got/want. I’ve had great luck taking care of some of my symptoms by just spending 20 minutes doing this! One person who followed along with the video said, “I only got through the head part of the massage before I fell asleep!”

The video is up on YouTube. If you are interested in a free and accessible self-care tool, check it out. Or if you’re just interested in a chuckle, because I’m new at making videos and it may make you laugh a few times. Plus, you get a peek into my private art studio. Find the video by following this link: https://youtu.be/8683cRXKQCI

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Insurance Updates

For me, this involves a few insurances. I have spoken to most of you about the changes I will be making if the changes will affect you so no worries if you haven’t heard about this before. Beginning this next year I will no longer be in network with Cigna or OHP. This has been a hard decision for me and I’ve really gone back and forth with it. I want each of you to get the best care possible and that factors big in my decision to drop these insurances.

For Cigna I will be able to bill out of network. I understand that this means your appointments will no longer go toward your in-network deductibles and that may be an insurmountable financial barrier to you. Please let me know if this is the case and we can work together to make sure you still get acupuncture.

Being a new practitioner, I am required to submit extensive paperwork and evaluations for each of your visits to be covered and I’m required to do this frequently. This means that every few visits I am required to have you complete more paperwork and spend a portion of our visit on data for the insurance company that is time not spent on your actual treatment. In return, I’m only being paid for 1/3 of the actual visit. In the end, this is leaving me with almost no payment to meet my basic expenses let alone the time I spend researching formulas, conditions or accessing continuing education. This just isn’t sustainable.

For my OHP patients, since April of this year, OHP has new requirements including authorizations for visits creating problems similar to those mentioned above. In fact, I have found it virtually impossible to get visits authorized in any sort of timely fashion, if at all. In addition, they are now grouping chiro, PT and acu visits all within the total visits allowed for any particular condition. This means you have to either chose one modality or your providers have to compete to get your visits. I will work with each of you to create an arrangement that works for you this next year so that you continue to get regular treatments. I’ve fretted over this extensively as I know that there are few folks in town who accept OHP and finding good providers can be difficult. You deserve as much choice as anyone in your care. To that end, I’m committed to creating something in the future that makes my services accessible still.

If you have any questions or concerns about this, please do not hesitate to contact me.

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Well Community Fund

The greatness of community is most accurately measured by the compassionate actions of its members. Coretta Scott King

Speaking of dropping OHP, I’d like to announce the beginning of a Well Community Fund. I am starting a fund that will help cover costs of treatment for folks who may not be able to otherwise access acupuncture. As a small start-up practice, it is difficult for me to provide hardship rates for those with low/no insurance coverage. This is extremely important to me and fundamental to how I want to operate. This fund will help me to cover the basic costs of operating while also providing excellent caring treatments to patients who might not otherwise get treatment. This fund will be accessible to patients whose insurance coverage is limited, or who have unmet high deductibles but need assistance meeting the cost of treatment until the deductible is met.

This fund will be a great way for you to participate in equity work! Equity work is a way we can engage in recognizing our individual privileges and working to share that privilege with those who face daily discrimination due to systemic racism, sizeism, ableism, cis-genderism and colonialism. From time to time, I’ll also open the fund up to groups such as Firefighters during the Eagle Creek Fire.

I’m working on ways to make it easy for you to participate. For now, if you’d like to “pay it forward”, just let me know as we’re finishing up your treatment and I can add any amount to your payment to go towards the fund. This will be a no-pressure opportunity!!

Healthy Holiday Air Travel Tips!

I just dropped my niece off at the airport for her first trip home since she started college here in Portland! It brought back so many memories of traveling home for the holidays when I first moved to the Pacific Northwest over 27 years ago! So much has changed since then, but there are a few timeless things I've learned about travel in those almost 30 years that I love sharing with patients. Below are my favorite ways to stay healthy while traveling (and I've traveled to a LOT of different places): 

• Above all else, don't stress too much! If you have a credit card, ID/passport, boarding pass, you're really good to go. (Of course any necessary medication or medical devices would be included in that). Don't let worrying about what you've forgotten add stress to your travels. Most of us are fortunate enough that we can buy a replacement toothbrush or extra underwear if we absolutely have to. 
• Plan on getting to the airport 2 hours early, especially during holiday travel. Weather can be unpredictable and traffic can be crazy too.  If you have to drive to the airport, this gives you just enough time for a plan B if you can't find parking (we've had to call a friend to move our car from short-term parking, the lots were so full!!). If you can take public transportation, planning to arrive 2 hours early gives you time for any delays that are out of your control. Security and check-in can take forever during holidays, getting there early takes some of the stress away. 
• Buy a cheap, over-the-counter bottle of saline spray. Use this the night before and day of your trip. Then use again the night you arrive and the next morning. If you are taking a long flight, use during the flight too. This keeps the sinuses doing their job! It also helps with recycled/dry airplane and airport air. If you're going somewhere with a completely different climate, especially if it is dryer or you will be in conditioned air/forced air heat and you aren't used to that, the spray can be used your entire stay too. Then I also use the spray the night before my return trip and the first night I arrive home. 
• If you're going somewhere warmer, I like to take a C/B vitamin. Check with your practitioner on this. It's not right for everyone and can mess with digestion. 
• For most people, some Gypsy Cold Care  or other cold/immune support tea can be easy to add to luggage and great to use at the first sign of any cold! I always pack some. 
• Take an empty water bottle to fill when you pass security or buy a large bottle of water after security. It's easy to get dehydrated during travel. Staying hydrated helps the immune system work at it's best and can prevent travel fatigue. 
• If you are traveling abroad, with a big time change, there is lots of easy to find information out there about how to adjust. I like melatonin at the time I should go to sleep at my destination (not my home time). This is a temporary supplement for the first night or two and the first night or two back home. 
• I always travel with a scarf, socks and layers. Lately, we've been housesitting in Hawaii and so we don't want to pack anything but sandals. I still pack a pair of thick socks as the plane gets cold once it reaches cruising altitude. I pack a scarf for the same reason. It also doubles as a blanket or beach sarong. In Chinese medicine, we believe in protecting the neck from cold drafts to prevent neck stiffness and colds too! And I take at least a light fleece to wear if I'm cold on the plane or the place I'm visiting has AC/keeps it colder than I'm used to. 
• Pack snacks. I always pack a few easy to travel with snacks like meat sticks, nuts, almond butter packets or fruit leather. This helps if you don't get enough food served on the plane, if it's nasty food, or if you have to buy it (it's always expensive!). It is also great for those unanticipated flight delays which seem to be the norm during the holidays! 
• If travel is stressful for you in general, some Rescue Remedy can be helpful too. You can get it in solid format also so you don't add another liquid to your pack. 
• Expect the worst! If you expect delays, grumpy people and lost luggage, you can just roll with it when it happens! More often than not, things really work out just fine and I've had some pretty fun experiences in holiday airports with delays (and some not so fun, let's be honest). 

In general, I've found that people are actually pretty sweet and upbeat during holiday travel as everyone is in the same boat. So, with a little bit of prep and a measure of self-care, holiday travel can be enjoyable or at least not too terrible. There are many other supplements and formulas that can support your travel! We have lots of tools to help you specifically so don't hesitate to ask your natural healthcare provider! Happy travels and happy holidays! 

Thanksgiving Wishes

It is my wish for you, my patients, friends and colleagues, that you are able to enjoy this holiday season with health and self-care. The culture we live in places a special emphasis on the time between Thanksgiving and New Years. It can often feel packed, stressful, exciting, busy, commercial, demanding, magical, marginalizing or any combination of these! Perhaps even all of these! (Just a quick shout out about the revisionist origins of Thanksgiving: this a great time to educate ourselves on the actual history of the holiday and perhaps take a minute to learn more about our Native American friends, family and neighbors.)

However you choose to or not to celebrate this week, there is a lot of emphasis in social media on food. This can be marvelously nourishing or triggering. My wish for you is that you are able to really connect with your body and it's needs. That you are able to just truly enjoy this week without worry, fears or judgement around food. That you are able to just relax and really experience the bounty at the table - that you find plenty at your table this week. I hope you can turn off all the voices that are shouting at us right now to avoid certain foods, to overindulge, to under indulge, to restrict or to live in scarcity mentality if you have plenty, to shop with guilt if you are on assistance, to be with family if it's not right for you, to give if you have more needs than resources to give and so much more.

My wish is that it is a safe time for you to be truly present with your needs. To be able to slow down and listen to your body and your spirit. To take time to yourself if you need it, to eat more if you desire it and to be present with every morsel, to leave early if you want, to express joy with abandon even if not everything is joyful, to grieve openly those who are not with you, to be treated with love and respect. 

And if it is a not a safe time for you to be really present with your body or emotions, that you are able to have compassion with yourself. Most of us truly want to treat our friends and family with lovingkindness, my hope is that we can give that same attention to ourselves. That we can witness our needs with kindness and care. Tomorrow is always a new day and sometimes what seems like a failure can actually be an opportunity to healing self-love. I'll share my own secret mantra with you: "May any suffering I encounter (my own or that of others) move through me like water and be transformed into compassion." 

Thriving During the Holidays with Chinese Medicine

This time of year my calendar starts to fill up quickly and, while I'm excited and grateful to have time with family and friends, there's a stress that starts to mount when I think about how scheduled everything is! Given the increase in social events and the shortening of days, this time of year can easily become stressful. It's such a common experience that you can't count on one hand the number of movies with family holiday stress as a central theme.  In fact, we EXPECT this time of year to be stressful. And yet, there is a beauty to this season that we desire to be in touch with. The warmth of a fire, the comfort of traditional family foods, perhaps the joy of snow. Of course, for others, this time of year may be particularly hard as the loss of loved ones can be especially poignant. How can we not simply survive this time of year, but rather thrive during it? What are some self-care tips that can increase our capacity to flex into this busy, dark, and cold time? 

Winter, which officially started this week according to the Chinese calendar, is symbolized by the contraction of freezing water or freezing ground. It is a time to turn inward and to slow down. So, maybe we don't make it to every holiday party? In fact, the Neijing, one of the most important texts of Chinese medicine, recommends that we go to bed early and waken with the sun (or later). Stillness is recommended and dressing warmly. One is to avoid cold, especially if sweating. Cooking should reflect the season too with slow cooking, roasting, baking and warming foods such as lamb and root vegetables. 

I've definitely been heard before saying that acupuncture can help you transition from one season to the next. Here are some ways that Chinese medicine can assist with the winter season:

• Moxa, in particular, can help to warm the body and restore the natural flow of qi so that hands and feet are warmer. Old injuries, susceptible to cold, can be relieved with moxa. Additionally, the immune system is strengthened by this practice.
• Acupuncture also helps to restore qi and enhances the immune system. AND, it's a great way to manage stress!! There are specific points too that can help with cold and flu symptoms. 
• Chinese herbs can help with common cold and flu symptoms by shortening duration or managing symptoms. They can also help with sleep and digestion among many other things. 
• Cupping and gua sha can help with upper respiratory colds, pneumonia and bronchitis. (I offer cupping only appointments too.)

I would like to acknowledge that this time of year can be physically extremely challenging for our homeless neighbors and for those who have challenges paying for food and heat. In Chinese cosmology, winter is a time to gather together around the hearth. This is symbolic of the necessity of community to survive the dark and cold days. A way to flex into this season and find more "warmth" ourselves, is to help others. Winter giving can strengthen our own connections to others and increase our sense of gratitude. 

There are many ways we can help ourselves at little to no cost: 

• Meditation
• Warm baths or hot showers (be sure to keep your hair dry or dry it before bed). Try adding a few slices of fresh ginger to your bath (or steep the ginger slices first in a cup of boiling hot tea water before adding to the bath)
• Warm drinks such as herbal teas. Lemon and ginger teas if you are starting to feel under the weather (I especially like cold care teas like Traditional Medicinals Gypsy Cold Care). In general avoid cooling herbs such as most mints or Yin Chin Hao (unless prescribed by a provider)
• Many people swear by elderberry syrups too when colds/flus are going around or fire cider
• Sinus washes before and after travel (especially air travel - I like to take a cheap bottle of saline spray for convenience) or when sinus symptoms first arise
• Saying no to too many activities, scheduling down time and protecting it
• Alternately, reaching out to friends and family if you find yourself isolating - many people host "orphan" holiday dinners where friends gather to provide the comforts of home for one another
• Have plans for alone time/self care during family visits (a quick, I need a nap or a walk can provide you with quiet self-care!)
• Puzzles, card games, etc can provide more quiet and still interaction when it's cold out
• Scarves - in Chinese medicine, we believe that protecting the neck from cold and drafts is really important. And it feels great! 
• Good boundaries - don't over commit to anything such as social plans, elaborate meals, etc. If you can afford a rental car when you go to visit family, or have access to taxies/Uber/Lyft etc this can provide a greater sense of freedom during an extended visit. And you know you can help out too by running errands for your hosts if needed! Additionally, planning time to show your spouse/partner your old haunts can provide them with a break from family. Or plan to reconnect with old friends over lunch/tea. The more you provide these opportunities for yourself, the more you might find you have energy and patience with family. Just because it's the holidays doesn't mean you HAVE to spend time with family. If family is not healthy for you, find a group of friends to spend your time with instead and be gentle with yourself if you feel guilty. If family is good for you, it's a great time for extra phone calls, or even letters! Especially to elderly family members who may be especially lonely at this time. 
• This is a great time to have a clear budget and understanding of your priorities.
• Ask for help. There are many organizations out there to assist with heat, shelter, food, holiday meals and gifts. This is a time of year when giving is especially popular (many non-profits are inundated) so don't be shy if you have a need! 

Just general cold-weather safety: 

• If you have a car: Put an extra pair of really warm socks, a scarf, hat and gloves, your car for emergencies - OR, make sure to travel with these if you don't have a set to leave in your car. Carry water and some non-perishable snacks with you in the event you are stuck somewhere. I leave my hiking boots in my trunk in the winter too. Pay attention to the temperature. Temps can drop suddenly leading to black ice. Be especially cautious if the temp drops to 34 or below. Bridges and overpasses freeze more quickly too. 
• If you don't have a car, be sure to have warm clothes with you and warm shoes at all times. Public transportation is often delayed when temperatures drop. 
• Check on neighbors, especially elderly, ill or disabled neighbors when weather gets bad. 
• Keep at least 2 days worth of food on hand if you can  -even just a few cans of soup is good for if we get ice/snow. 
• Be sure to refill any medications/medical equipment BEFORE you run out in the event you can't easily get to the pharmacy. 

So here's to a warm, nourishing winter! Be well friends! 

Insurances and Billing

I'm currently unable to accept most insurances, but I'm offering flexible payments until I can accept insurance. Insurances require that providers apply to each individual company and some can take up to several months to get "credentialed" with (to be a provider that can bill that insurance). 

In the meantime, I can charge HSA cards, provide super bills and I can offer to work with you on a payment that allows you to be treated now rather than waiting for me to be able to bill your insurance. After I am contracted with insurances, I am unable to discount my services beyond a certain percentage for time of service payments. There are still options to make it work if you are under-insured. Just ask! 

Let me know if you have any questions about my rates, insurances etc.