Wouldn’t it be great if your health insurance provider covered the costs of your massage, acupuncture, and nutritionist?
If you’ve ever sought out shiatsu for tendonitis or aromatherapy for frazzled urban nerves, then you’ve contributed to the $48 billion Americans spend every year on complementary, alternative or holistic medicine. That eye-popping sum is thanks to the tens of millions who see alternative medicine as the best way to treat a range of both chronic and acute maladies and conditions for which Western medicine (with its foundation in surgery and drugs) does not enjoy a high rate of success—insomnia, sleep apnea, migraines, menopause, back pain, carpal tunnel syndrome, infertility, skin conditions, allergies… the list goes on.
With the alternative health sector surging, giant insurers are starting to notice the fact that holistic treatments are cheaper than surgery, a lifetime of prescription refills or Western-style occupational therapy. As a result of personal experience and about 20 years in the insurance business, Steve Gorman, founder of Alternative Health Insurance Services, which helps clients find group insurance plans that cover holistic medicine, believes that alternative therapies are cost effective. “If you can prevent somebody from getting a major illness, even if it costs a little more on the front end… that would save tons and tons of money, rather than waiting until someone has a disease and then treating it.”
Insurers, in other words, are starting to catch up with their policy holders, who are already spending out of pocket to hire their own acupuncturists, naturopaths, rolfers, energy workers, herbalists and the like. But unfortunately, the big corporate carriers are making up ground slowly. In fact, so are smaller carriers. Gorman’s company is one of the few—if not the only one—of its kind.
Progress and barriers
As with their emphasis on “preventative medicine” in the 1990s, insurers are wading in slowly when left to their own devices (except in the case of Washington State, but more on that later). A 2002 study at the University of Maryland School of Medicine found that a dearth of information about holistic medicine’s clinical efficacy has kept insurers from incorporating it faster. Insurers and doctors alike have long been skeptical about the benefits of alternative therapies because the treatments—from massage to Chinese herbs—have not undergone the rigorous scientific testing to which conventional practices are subject, or at least not through the same respected (often corporate) channels.
The inroads alt medicine has made with insurers can be traced back to 1991, when Congress appropriated a modest $2 million to the National Institutes of Health to study alternative medicine, laying the groundwork for what is now the National Center for Complementary and Alternative Medicine (NCCAM). Part of NCCAM’s mission is to fund scientific studies that contribute to the growing body of “official” scientific information.
Today, anywhere from one-third to almost half of expenditures for alternative medicine are out of pocket, but it’s a statistic, skewed by chiropractic’s mainstreaming, that would otherwise be much higher.
Michele Hangee-Bauer, office manager at SOMA Acupuncture and Natural Health Clinic in San Francisco, deals directly with all of the insurance paperwork that comes into the clinic. She says that mostly partial benefits are available on some from Blue Cross of California, United Health Care, Great West Guardian, Aetna, Cigna and Gallagher Bassett. Sometimes she gathers information from the client, then calls up the insurance company and asks about coverage; other times, clients ask her to sign claims they’ve already submitted to their insurance companies.
The preponderance of health administrators and holistic practitioners think that insurance coverage will continue to grow. Insurers, says Dr. Hal Richart, the public relations chair for the Illinois Chiropractic Society, are going to have to figure out how to effectively service the aging baby boom generation. As they age, he asserts, this influential generation is going to demand more musculoskeletal services—and that growing demand will help change the medical insurance terrain.
Washington State, and where the big players stand now
Insurers tend not to offer coverage in their standard HMO and PPO plans, instead offering it only if members pay higher deductibles, purchase riders that expand their normal coverage, or join a contracted network of providers.
For example, Aetna, available in every state except Alaska, offers some plans that have a benefit for chiropractic and acupuncture, but the coverage is fairly limited. Aetna also offers a discount program called Natural Alternatives, where subscribers can select from a directory of providers who offer discounts on their chiropractic, acupuncture, massage and nutritional services.
Blue Shield of California offers 20 percent discounts for visits to some holistic practitioners, but employers choose if that option is a regular part of their plan or if they’ll make employees pay extra for it.
Kaiser Permanente members are eligible for 25 percent off holistic services. It collaborates with Healthyroads, which provides members with access to dietary supplements, a network of holistic providers and scientific information about healthcare. Kaiser also offers classes such as yoga and Qigong at its facilities, with a discount for members.
But Gorman says it’s not enough to have alternative treatments as options; they’ve got to be structured into regular plans. Washington State is the nation’s sole exception to the minimal offerings rule: Every state-regulated insurance plan must cover some number of licensed alternative practitioners, including chiropractors, massage therapists and acupuncturists. As a result, Washington State has been the site of studies that track the efficacy and costs of complementary and alternative care.
Some hospitals not waiting
But in the rest of the country, insurance company hesitancy is being addressed by hospitals themselves, where alternative and conventional doctors are teaming up to offer integrative medicine.
Nicole Cyrille was diagnosed with breast cancer in December 2005, and after a visit to the Cancer Treatment Center of America in Philadelphia, she decided to use their combined contemporary medicine/alternative medicine approach to cancer treatment. In addition to eight months of conventional chemotherapy and radiation treatments, Cyrille met regularly with a naturopathic doctor, whom she now trusts without question. She won’t even let her husband buy her tea without consulting her naturopath, she says. As part of the hospital’s offering, she also practiced visualization and relaxation techniques with a mind-body therapist to reduce the stress of chemo. “After 35 cancer treatments, I didn’t have one side effect,” Cyrille says enthusiastically. “I lost my hair, but it’s all back again.”
Thanks to her husband’s retirement insurance plan through the Port Authority of New York and New Jersey, Cyrille hasn’t had to pay for any of her treatment except herbal supplements. “I pay every month less than $200,” she says.
Normalizing the relationship between alternative and conventional medical practitioners and conducting scientific studies about the efficacy of alternative-complementary medicine will contribute to wider acceptance by insurance companies and regular benefits for plan members. Meanwhile, check with employers and their insurance providers to find out what integrative treatments, if any, are part of a particular group or individual plan—and if you don’t see the treatments you want, ask for them. Milan Polak, co-creator of Learn2Heal, an LA-based organization providing affordable holistic medicine services to underserved communities, says this last step is the key.
“It’s a simple issue of supply and demand,” Polak explains. “You shouldn’t blindly accept whatever prescription your physician doles out; you should ask for holistic care every time you visit—just as you should request that alternative modalities be covered by your insurance provider. And if you are denied, make it known that you’ll seek a doctor or provider who will service your request. The more of us who raise our collective voices in support of these services, the more likely we are to change healthcare.”
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