There was a time when you couldn’t find any health insurance coverage for alternative medicine of any kind. From herbal remedies to naturopathic doctors, most insurance companies refused to cover anything even remotely considered to be a service outside the realm of mainstream medicine. However, in the words of the folk icon, Bob Dylan, The Times They Are a Changin’.
Although coverage is still limited and anything but consistent from one insurance provider to the next, many ‘alternative’ treatments are now being recognized by the AMA and are consequently covered by an increasing number of insurers. Here is some of what you should know about alternative medicine and health insurance coverage.
What Exactly Constitutes ‘Alternative’ Medicine?
In simple terms, alternative medicine refers to anything that falls outside the scope of what is considered to be ‘mainstream’ treatments and medications. Some people refer to it as Complementary medicine while others call it Integrative medicine. The industry even has a name for this school of thought and it has now been labeled as Complementary and Alternative Medicine, usually abbreviated as CAM.
According to the globally renowned Mayo Clinic, integrative medical practices that constitute our understanding of CAM include such things as acupuncture, massage therapy, and animal-assisted therapy. Other sources list chiropractic, biofeedback, naturopathy, hypnosis, homeopathy and electromagnetic therapy as CAM practices, and again, coverage varies from insurance company to insurance company.
The Cost of CAM and Out-of-Pocket Expenses
As mentioned, many times those patients seeking CAM above conventional medical treatments need to pay out-of-pocket for those treatments. Unless patients had an HSA (Health Savings Account) or an FSA (Flexible Spending Arrangement), the totality of expenditures were paid for by the patient. Medicare is one insurance provider that covers very few CAM practices.
Those services Medicare will agree to would only be under the condition that they are prescribed as medically necessary. Typically, a doctor must bear the burden of proof that other treatments have been tried and failed. Being that the cost of most medical treatments, conventional or complementary, are outside the realm of what most people can pay, fees associated with CAM are often unaffordable.
Issues Which Need to Be Ironed Out
Speaking of Medicare and the cost of CAM treatments, one of the newer problems coming to light is in terms of medical billing. Since these practices are, for the most part, not recognized by the AMA, what are they called? Remember, medical coders and billers follow an industry-wide set of codes which must be entered when billing for services (or medications) provided.
Today’s medical billers are becoming more and more comfortable with these procedures and many treatments now have their own codes. If you are considering studying to be a medical coder/biller, read about your options to find the right school that will give you a strong background in CAM. You must first understand what it is and then learn about those treatments you can safely bill insurance providers for.
Time Honored Treatments Still Outside the Medical Arena
For literally thousands of years, people have been using such things as herbal remedies, acupuncture and Ayurveda. In fact, Ayurveda has been practiced for more than 3,000 years. Born within the ancient cultures of India, Ayurvedic medicine is a holistic approach that affects healing through a mind, body, spirit approach and is still widely practiced in that area of the globe.
Ayurveda consists of diet, massage, meditation and of course herbal therapies that have proven to be effective in the past and the practice has been gaining in popularity over recent years. There are two central guiding principles involved which first state the there is an inextricable connection between the mind and body, and secondly that there is nothing more transformative than the mind. You may have heard people expounding the benefits of “mind over matter” and perhaps this is where this cliché originated.
How to Obtain Coverage from Your Insurance Provider
The first thing you will need to do is see what CAM treatments are potentially covered by your provider and what it takes to get approved. Even treatments which ‘can’ be covered aren’t always approved and this is where your medical doctor comes into play.
Since most doctors are now refusing to prescribe controlled substances for pain and since there are proven effective treatments available in complementary medicine, your doctor can put in writing (prescriptions) that these treatments are medically necessary. In a nutshell, that is the key to getting your provider to pay for CAM treatments.
The Importance of Working with Your Doctor
It cannot be stressed enough just how important it is to work with your doctor when seeking alternative treatments. Some are wild conjectures postulated by people who have no medical background and have simply formed their own conclusions with no scientific data to substantiate their claims. These kinds of treatments can be both ineffective and dangerous.
Other times, the CAM procedures or treatments you are considering are backed by research and although not conventional treatments, are becoming more and more recognized within the medical community. For your safety and to ensure insurance coverage, it is necessary that you work with your own doctor or specialist.
You Are Ultimately in Charge of Your Own Care
There are too many false claims being made about the safety and efficacy of alternative treatments and so you will always want to know more about what is being recommended. In the end, your healthcare is your responsibility because you alone have the final say. Your doctor cannot force you to do, or not to do, anything as the case may be, so you are ultimately in charge of learning as much as possible before seeking alternative treatments.
Yes, the medical community is slowly coming around to recognizing many complementary treatments previously frowned upon, but that doesn’t mean all are safe or effective for what ails you. Work closely with your medical provider and it just may be possible to find alternative treatments you won’t need to pay out-of-pocket and will give you the relief conventional practices were unable to treat.