Coverage for alternative treatments rises, and trend has yet to peak
November 23, 1999
Web posted at: 11:54 AM EST (1654 GMT)
By Kathleen Doheny
You're sitting in a more ergonomically sound task chair, but your back still hurts. You'd like to see if acupuncture will help you feel better.
Or, you worry about the side effects of tranquilizers and wonder if massage therapy could help you calm down without swallowing a pill.
You figure your health plan won't cover these treatments, and if you want to try them you'll have to find your own practitioner and cover the expenses yourself.
The alternative trend
Managed care organizations and health insurance companies are becoming more open-minded about covering alternative treatments. Fueling the trend: consumer demand, a growing body of evidence that some of the treatments work and, much less often, government mandates.
In Washington state, a law that requires insurance carriers to cover various categories of providers is back in effect after legal wrangling with the insurance industry. Earlier this year, the U.S. Supreme Court decided not to hear the case.
Known as the every-category-of-provider law, the statute stipulates that health plans cannot exclude any category of health care professional licensed to provide care for a condition that is covered by the basic health plan. "It doesn't change the contract," says Jim Stevenson, a spokesman for Washington Insurance Commissioner Deborah Senn. Under the law, a carrier must allow a subscriber to choose between providers in different categories (say, an internist or an acupuncturist for back problems) when both are licensed appropriately to treat the condition.
"A handful of other states have taken this up, category by category," Stevenson says, with many focusing first on chiropractors, acupuncturists and naturopaths.
The alternative survey
But even without mandates, health insurers are beginning to offer more coverage for alternative treatments. In a survey of 114 HMOs, 67 percent report offering at least one type of alternative health care, says Kevin Buron, a spokesman for Sacramento, California-based Landmark Healthcare, which markets alternative medicine programs to managed care organizations. The 1998-99 survey was conducted for Landmark by an independent marketing research company.
Chiropractic is the most commonly offered type of alternative care, with two-thirds of HMOs surveyed covering the treatment. Acupuncture and massage therapy are second and third most common, offered by 31 percent and 11 percent, respectively. Much less common: vitamin therapy, relaxation therapy and herbal therapy. Nearly three-quarters of the HMO executives surveyed said they expect consumers to continue demanding additional alternative medicine coverage. And the HMOs cite consumer demand as an important reason for covering some alternative treatments.
HMOs are leading the trend, Buron says, but they are joined by some fee-for-service plans. Mutual of Omaha, for instance, covers the highly publicized Dean Ornish program to reverse heart disease with diet, exercise, stress management and counseling in its fee-for-service and managed care plans, says spokesman Jim Nolan, even though the tab is $6,000 to $7,500. "Part of the reason we cover is, it's been clinically proven to be effective," he says.
And further scientific study about alternative care is emerging. In 1998, the Journal of the American Medical Association devoted an entire issue to alternative medicine, noting that four out of every 10 Americans use some form of alternative treatment.
Among studies examining the effectiveness of alternative therapies, one found that moxibustion (burning of herbs to stimulate acupuncture points) works better to correct the breech birth position than doing nothing. However, another study found that an herb used for weight loss, garcinia cambogia, was not necessarily effective.
When health insurance plans do add coverage for alternative therapies, it usually falls into one of three categories, Buron says. Core programs cover alternative therapies just as they do traditional treatments. Rider programs offer optional coverage for alternative medicine for an increased fee. Discount programs offer referrals to alternative practitioners who have agreed to discount their fees.
To find out if your insurance plan covers alternative treatments, call member services or ask your employer. If the plan doesn't offer the treatment you want, consider talking to your employer to see if coverage can be added. Or appeal directly to your insurance company or managed care plan. At Mutual of Omaha, says Nolan, such appeals are handled on a case-by-case basis.
Copyright 1999 WebMD, Inc. All rights reserved.
RELATEDS AT :
How to use alternative and complementary medicine
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National Center for Complementary and Alternative Medicine
The Chiropractic Resource Organization
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