What’s needling acupuncturists in Maryland? Growing demand and insurance headaches.

Acupuncture in Maryland is having a moment.

The number of people licensed to practice in the state has jumped by more than 25% in the past decade as more people are looking for drug-free relief and insurance has started to foot the bill.

Brian Bieda at Awaken Wellness in Columbia, for example, says his practice has been logging up to 850 sessions a month for conditions such as chronic pain, stress and anxiety, even infertility.

But with mainstream success have come mainstream problems.

Providers in Maryland are wrestling with a major insurance snafu that has held up tens of thousands of dollars or more in their reimbursements. Longtime practitioners are battling new competition. And the Trump administration’s tariff policy has jacked up the cost of importing the practice’s primary tool — the needle.

The insurance trouble with CareFirst BlueCross BlueShield, the state’s largest insurer, is particularly straining providers and their patients this year. Bieda said one of his patients has $1,000 in outstanding claims and fears being on the hook to pay.

“We treat anxiety, stress,” he said. “The last thing people need is to be stressed by insurance.”

The lack of payments since January could make it tough to continue treating patients, or accept new patients. Bieda’s wife, independent acupuncturist Jennifer Stukey, has put sessions on hold for one regular chronic pain patient.

CareFirst officials acknowledged the trouble. A spokesperson said earlier this month that the insurer is wrapping up a move to a new claims and enrollment system. Officials said problems should be fixed by month’s end.

“The latest stages have caused some processing delays,” said Crystal Mitchell, the spokesperson. “We appreciate their patience and partnership.”

Interest in acupuncture in Maryland mirrors global growth in demand, with analysts predicting even more interest in the cornerstone of traditional Chinese medicine.

Acupuncture involves stimulating the nervous system by inserting hair-thin needles into any of more than 2,000 specific points on the body, releasing chemicals to promote healing and reduce inflammation and pain.

The needles may be heated or contain a mild electric current.

The India-based analytics firm Precedence Research estimates that the market worldwide will almost double to $105 billion by 2035 due to “increasing acceptance of alternative medicine, increased demand for drug-free pain management, increased insurance, and increases in the elderly population.”

The firm specifically cited “stress-related diseases” for attracting consumers.

But that surge could be tempered by rising costs.

One acupuncturist blamed tariffs for a 25% increase in the cost of the machine to apply the current. The needles themselves faced a 145% import tax at one point last year.

The demand for services is also attracting other providers, an encroachment that worries some about training standards.

Physical therapists and athletic trainers are increasingly offering emerging services such as dry needling, using needles to ease “knots” in muscles, and cupping, using suction to improve circulation and reduce muscle soreness.

Lindy Burns, president of the Maryland Association of Acupuncture and East Asian Medicine, said acupuncturists typically need a master’s degree and often have other training, depending on their services.

Many larger health care systems, including Johns Hopkins Medicine and the University of Maryland Medical System, have added acupuncture to their integrative medicine practices. Burns’ patients, for example, use acupuncture to help control pain during traditional cancer treatment.

Many smaller practices got a boost after the federal Affordable Care Act allowed states to include acupuncture as a covered benefit in health insurance plans, and about a half-dozen states, including Maryland, did in 2014.

Medicare and Medicaid, which provide coverage for seniors and low-income residents, also cover acupuncture in limited circumstances. Other private plans have also been adding the service.

While gaining health insurance coverage has fueled demand for their services, practitioners say it also comes with bureaucratic headaches.

Burns said some practices have started to avoid the hassles of insurance, which could limit access to those who can’t pay out of pocket. Costs of a session vary, but can exceed $100.

Hung-bin Ding, associate professor of management in the Sellinger School of Business and Management of Loyola University Maryland, said the majority of acupuncturists still operate independently on slim margins. That means all the pressure of a mom-and-pop business but with all the professional and legal requirements of a health care provider.

Ding said acupuncturists must be licensed and use needles approved by the U.S Food and Drug Administration. He said they are only imported by a small number of wholesalers.

“They have a lot to live with, a typical entrepreneurial situation,” he said. “And it’s hard for them to change the dynamic, even though the overall market and demand are growing.”

Those pressures have been felt acutely at Mend Acupuncture, which has grown into the largest in the state with three locations and 20 acupuncturists. About 65% of patients are covered by CareFirst, said Sarah O’Leary, the founder.

O’Leary dipped into savings to make up for more than $150,000 owed by the insurer for hundreds of sessions. She said she’s unsure how long she can continue serving patients on affected plans, many of them state employees.

She was among about a dozen providers, including several acupuncturists, who contacted The Banner about reimbursement struggles, saying they spent hours on hold trying to get assistance from the insurer. Ten acupuncturists also filed 43 complaints this year with the Maryland Insurance Administration about CareFirst.

O’Leary said she’s gotten busier every year since the pandemic.

“Insurance opened the gate for more people to get care,” she said. “If we drop out, suddenly a lot of people won’t have access.”