Positive Problem-Solving Session for DOMs

Save the Date:  Wed. July 22, 2026, 6-8 pm

Town Hall via Zoom

 

Let’s use the Fire Horse energy of the year to communicate in our profession and make progress. No one else will do it for us, or if they do it without DOM input, the results may well be unsatisfactory for our patients as well as our profession.

 

Moderated by our own Dr. Yvette Arellano, DOM, NMSAAM President

 

Zoom allows us to be on equal playing field across our state, the 5^th largest in USA. We largely hated it during Covid, but now we often realize how convenient it can be.

 

Zoom link will be sent to all DOMs who have chosen to be on the  NMSAAM email list. We will hold to two hours to whet your appetite for DOM live communications and the subjects.

 

Discussion Topics:

 

1. DOM practical exam in NM

• RLD would like to scrap the NM practical exam required for getting a license to practice acupuncture and Oriental Medicine in NM.
• The issues are that since our acupuncture schools have closed, there are less applicants.
• However, EMTs and optometrists have a practical exam to practice in this state.
• It costs a lot to administer the exam.
• Do we want to dumb down our profession to be like everyone else in other states? Ours is a psychometrically valid exam that demonstrates a provider’s live hands-on ability to practice, which is simply not seen by written exams.
• This is a call to members and the profession for opinions on the importance of the exam.
• Do we want to start whittling away our very strong scope of practice? Once it is gone, we will never get it back. NM is number 1 along with less than a handful of other states. We are number 1 in something positive!!

2. DOM insurance concerns: a problem-solving session

• Purpose: to get us all together to discuss and find solutions.
• Both practitioners and patients are getting incorrect information from insurance companies.
• It has been suggested that we should broaden our focus on opening insurance panels to Small Business Administration since we are small businesses in an important health care profession in the state that is severely lacking in timely health care in NM.
• Note that we have not been able to make inroads with the Office of the Superintendent of Insurance, not for lack of trying. In reality, that office has a different mission and job than helping us to deal with health insurance companies. Their mission and mandate are to protect the public.
• Remember that we are stronger together! Many of us are lone practitioners and can get the run-around.
• See the possible insurance discussion questions to consider below in 2a:
• Remember that we can’t discuss specific payment fees here, just all the other issues.

3. DOM possible opportunities

• We may have a possible opportunities with the increasing shortage of MDs and other biomedicine providers in NM.
• We do not want them to go, as we mostly all also need biomedicine.
• However, how can we help and fill in some of the gap?
• See this concerning article about MD shortage & future shortage projections:
• https://www.thinknewmexico.org/health-care-worker-shortage/

 

 2a. DOM insurance problem-solving questions

Compiled by NMSAAM Insurance Chair, Dr. Caterina Di Palma, DOM
Silver City, NM

First, Dr. Di Palma’s introduction to this topic:

The NMSAAM BOD knows that the biggest obstacle to many DOMs in building a successful and lucrative practice is being included on health insurance company panels. This has been discussed for countless years; letters and meetings with the insurance czar, but health insurance companies have yielded no change.

In preparation for this Insurance Townhall, a new tactic has been presented. We, DOMs, businesses offering acupuncture and Oriental medicine services, are small businesses. As such we could/should ask help from the Small Business Administration. The mandate of the Small Business Administration is to encourage, educate, work with small businesses to help them (us) succeed. An important obstacle to our success is the refusal of health insurance companies to open their panels to all qualified DOMs who would like to provide services to their members.

Additionally, in a state woefully lacking in medical professionals and adequate medical services, our expertise is being denied to our neighbors.

This should/could be brought to the attention of the Governor, the Small Business Administration, and again to the Insurance czar whose mandate is more to protect the public.

Please consider the following questions, and come to the town hall to discuss them with your colleagues. If you have other questions or comments, you can contact us through this website comments section and/or email at info@nmswaam.org.

The Questions to stimulate your problem-solving self:

1. Are you a provider for any health insurance companies? Which one(s)?
2. If not, why?
3. What are your successes or failures with health insurance companies?
4. Do you use CAQH for credentialing? Other credentialing organizations, such as Tivity for the VA?
5. Do you use Clearing Houses, if so which ones?
6. Do you call or use Availity, or health insurance company websites to verify eligibility and benefits?

• • Do you have any issues getting correct information when verifying eligibility?
  • Do you get correct information when verifying acupuncture benefits?
  • For acupuncture benefits, are you made to request pre-authorization?
  • When you call to get pre-authorization, are you told you do not need pre-auth?

7. When you call BCBS and are forced to get through the automated line, have you  been told that pre-authorization is required and that there will be a penalty for submitting a claim before getting pre-auth?
   • Then when calling to get pre-authorization, does the agent/representative tell you that no pre-auth was necessary for that particular plan.

8. Do you use the Presbyterian Provider Portal website? Is it helpful? Have you had problems with it?

• • Have you had problems with particular plans, such as Dual Plus Plan, Senior Medicare Advantage plans?

9. If you are a provider for the Veteran’s Administration, what are your experiences with the VA or TriWest?

• For the VA, experience with HSRM website? IDme sign in verification?
• What were your experiences as TriWest expanded to PGBA to Tivity to Whole Health Living and it’s programs?
• Did you automatically become a provider for Humana, Whole health Living and its programs because you were credentialed for the VA by Tivity?
• Do you know that you can refuse to be a provider for those other groups that do not pay you for the totality of what you do as a DOM?

 

10. What is your experience as health insurance companies turn to third party payers?

• What is your experience with American Specialty Health?
• Optum?
• Other third-party payers?
• What is your experience with UHC, and its various plans?

 

11. Do you have any experience with other newer, or less known health insurance companies?

 

We look forward to good discussions and networking with our colleagues across the state.

• It is not neccessary to be an NMSAAM member to come to this townall.
• It is neccessary to be on our email list.
• It is neccessary to be a DOM.
• Contact nmsocaam@gmail.com or info@nmsaam.org to be included in the NMSAAM email list.
• Please do not expect immediate response, but there will be a response within 2 weeks.