Alternative Medicine and Your Health Insurance: How to Get More Out of Your Plan

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In recent years, the number of Americans that use alternative medicine has recorded steady growth. A 2007 survey by National Health Statistics Report found that four out of 10 respondents sought some form of non-traditional medical treatment. However, despite billions of dollars spent annually on alternative medicine, most of these services are not currently covered by the majority of health insurers.

According to the NHSR, the complementary and alternative medicine (CAM) industry generated roughly $40 billion in annual revenue in 2007. However, adults in the United States spent roughly $33.9 billion out of pocket on alternative treatments that year. The majority of these expenses ($22 billion) covered self-care costs, including natural products, fitness classes (yoga, tai chi, etc.), and homeopathic medicine; the remaining $11.9 billion was spent on practitioner visits.

despite billions of dollars spent annually on alternative medicine, most of these services are not currently covered by the majority of health insurers…health insurance companies still regard most alternative techniques with uncertainty

According to the National Institute of Health, treatments that are more commonly covered by insurance include chiropractic, acupuncture, and massage. However, health insurance companies still regard most alternative techniques with uncertainty. Treatments that are not included in most traditional health plans include herbal therapy, homeopathy, applied kinesiology, and naturopathy. Though these procedures may not be covered, alternative healthcare costs could be reduced if policyholders better understood insurance policies and options.

 

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Your Alternative Care Budget (Bigger Than You Think)

Out-of-pocket alternative medicine expenses — including various supplements, health care products, and clinical visits — stand to accumulate over the course of a year, especially if more than one family member is benefitting from CAM treatments. The NHSR notes that the average American adult spends $121.92 per consultation with an alternative health care provider, and pays $29.37 out of pocket for each visit. In addition, roughly 20 percent of patients who received acupuncture, hypnosis therapy, or other alternative treatment paid at least $75 per visit. The average adult spent $30 per purchase for CAM products; however, more than 5 percent paid at least $120 per purchase.

Although some alternative procedures and products are now covered by insurance, there are still many limitations placed on them when it comes to costs. Ultimately, limited coverage can mean limited benefits for the patient.

The NHSR notes that the average American adult spends $121.92 per consultation with an alternative health care provider, and pays $29.37 out of pocket for each visit

One option for obtaining coverage for alternative medicine costs is through a Health Savings Account (HSA). Implemented by the U.S. Department of Treasury in 2003, HSAs are available to individuals with high-deductible health plans who do not receive additional coverage (including Medicare). Money deposited into this account is tax deductible and tax-free when used for medical purposes; this enables account holders to undergo periodic medical evaluations, receive immunizations, and obtain screenings for cancer, heart disease, infectious diseases, and other conditions. Additionally, the extra savings can help policyholders avoid the financial stresses of any health insurance loopholes of a high-deductible plan.

Another option is a Flexible Spending Arrangement (FSA). Money placed into an FSA is pre-tax, but it must be used by year’s end for health care costs. According to Daily Finance, an FSA may cover certain alternative services, such as hypnotherapy, acupuncture, and chiropractic care, as well as programs that aid in addiction recovery.

The Best and Worst Alternative Care Coverage

Many individuals with health insurance plans have found that ‘approved treatments’ are only partially covered, causing them to incur sizable out-of-pocket expenses. Prior to receiving CAM treatment, patients should meet with their insurer to discuss certain aspects of their current health coverage.

  • Does the provider accept the current insurance plan?
  • Is it necessary for the provider to be part of the plan’s network?
  • What additional costs will be covered (supplements, tests, supplies, etc.)?

According to a recent article co-authored by U.S. News & World Report and Duke Medicine, the optimal health care plan for most individuals includes integrative medicine. Defined as a combination of traditional medicine and alternative therapy that achieves the best possible results for any given patient, integrative techniques include acupuncture, bio-field therapies, guided imagery, hypnotherapy, and yoga. While the article notes that most integrative techniques are not covered by traditional health plans, patients should meet with insurance representatives to determine the extent of their coverage.

Some health insurance providers cover various natural supplements and alternative therapies. Dr. Tyler Woods of eMaxHealth writes that Aetna offers a 15-percent discount on more than 2,400 natural products and services, including herbal supplements, aromatherapy, and homeopathic remedies. Kaiser Permanente is another example; the Oakland-based firm recently began offering coverage for acupuncture, chiropractic care, and other CAM treatments.

Before purchasing an insurance plan with alternative healthcare options, patients should shop around to find a provider that caters to their specific needs. Important considerations include:

  • Which forms of alternative medicine are considered ‘alternative’, and which ones are not?
  • Does the plan cover alternative medicine for all existing needs of yourself and family members?
  • What limits are placed on the costs or alternative treatments for each need?
  • Do practitioners of alternative medicine need to be in the network? If so, are they nearby?

Get More Out of Your Current Plan

Concerning the patient’s payment options for integrative medicine, some employers offer health care reimbursement accounts. This type of system will often pay for services rendered by alternative care specialists, but a plan that includes alternative care will generally cost more.

According to Health.com contributor Jeanne Lee, patients can receive insurance coverage for CAM health care expenses by obtaining a prescription for these services from their primary physician. This prescription must include the diagnosis, as well as frequency and length of the necessary treatment. While this measure will not guarantee coverage, many insurance provider’s will approve all doctor-approved physicians. The most commonly approved services include chiropractic care, massage therapy, and homeopathy.

Another approach, Lee notes, is to meet with insurance representatives to discuss the relatively low cost of alternative treatments compared to conventional medicine. For this reason, patients who receive CAM services should always obtain a receipt from their health care provider(s); an alternative treatment that costs $300 will appear considerably more attractive to insurance companies than a $15,000 conventional procedure that addresses the same medical condition.

Finally, Lee encourages patients to seek out affordable health care providers if alternative expenses are not covered by their insurance plans. Many colleges and training centers offer discounted services for acupuncture, chiropractic care, naturopathic medicine, and other CAM-related practices. In many cases, these consultations will cost between $10 and $60.

always obtain a receipt from [your] health care provider(s); an alternative treatment that costs $300 will appear considerably more attractive to insurance companies than a $15,000 conventional procedure that addresses the same medical condition

While some progressive insurance companies currently cover certain CAM treatments and services, most alternative techniques require the enrollee to pay out-of-pocket. However, there are several ways to obtain these treatments at a lower price — and receive partial to full coverage from an insurance provider. Patients are encouraged to research insurance companies extensively, compare plans to see which alternative services are offered, and discuss reimbursement options with their employers.

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