Feature Archive

Providing the Alternative

Complementary Coverage?

By Carol Sorgen
WebMD Feature

Reviewed By Gary Vogin

Your cousin tells you acupuncture has really helped her migraines. Your sister swears by chiropractic for her stiff neck. You wouldn't mind exploring some alternative therapies for a few of your own ailments, but you're not crazy about the idea of paying for the treatments. Well, you might not have to. Traditional insurance carriers are realizing that if they want to keep their customers satisfied, they need to jump on the CAM (complementary/alternative medicine) bandwagon themselves.

A 1998 study published in The Journal of the American Medical Association reported that the use of alternative therapies in the U.S. is on the rise. According to the report, 42% of adults used at least one form of alternative medicine or therapy in 1997, spending more than $33 billion.

"We're always looking for the quick fix," says Rick Gallion, director of complementary and alternative medicine for Blue Cross Blue Shield of South Carolina (BCBSSC). "We need to rethink how we can help the general public avoid disease."

A self-confessed "health nut," Gallion oversees BCBSSC's Natural Blue program. Begun in January 1999, Natural Blue offers policyholders discount fees for chiropractic, acupuncture, and massage services provided by a network of BCBSSC-approved providers.

"We emphasize quality providers," says Gallion. "There is a stringent qualifying process for the public's protection."

Because Gallion believes that educating -- as well as protecting -- the public is paramount, BSBSSC also includes information on complementary and alternative medicine on its web site -- www.southcarolinablues.com -- where you can click on "natural blue" and submit questions, as well as search for information on a variety of CAM topics.

Since there are no claims to file with Natural Blue, Gallion has no data on just how many people have taken advantage of the program. There has been a lot of positive feedback, however, he says, and in the last three months, the Natural Blue web site has received 27,000 visitors.

Blue Cross and Blue Shield of North Carolina (BCBSNC) is another insurance carrier seeking to capitalize on its subscribers' interest in alternative therapies. Alt Med Blue, a comprehensive alternative medicine discount program, was begun in April 2000. North Carolina's program is more extensive than South Carolina's Natural Blue -- with discounts offered not only on acupuncture, chiropractic, and massage, but also on yoga, stress management, personal trainers, fitness centers, spas, homeopathy, naturopathy, and nutrition counseling.

In announcing the program, BCBSNC's chief medical officer, Robert Harris, MD, said that Alt Med Blue gives members a choice of services that "promote good health."

As alternative medicine practitioners come up with more "hard science" to back up their claims of effectiveness, insurance carriers will be more likely to add coverage for these therapies, says Anna Silberman, president and CEO of Lifestyle Advantage in Pittsburgh.

Lifestyle Advantage, a subsidiary company of Highmark Blue Cross Blue Shield, believes so much in one alternative/complementary medical model -- Dr. Dean Ornish's Program for Reversing Heart Disease -- that it completely pays for its costs. For 10 hours a week patients take part in such activities as moderate aerobic and strength training, yoga, meditation, guided imagery, and visualization, in addition to following a low-fat diet with additional supplements such as fish oil and soy.

"I call this the trifecta," says Silberman. "A program such as this benefits patients, health plans, and providers. I've never come across an intervention that benefits all three entities."

Because of the success of the Ornish program, Highmark is now beginning an Osteoporosis Prevention and Education program, and before the end of the year, Dr. Ornish's prostate cancer prevention program.

BCBSSC, BCBSNC, and Highmark BCBS are just three of the carriers nationwide who have been promoting CAM therapies to their patients. There are certainly more, but according to Eric Wurzel, not enough. Wurzel, a partner in Travers, O'Keefe, a New-York based insurance and employee benefits-based brokerage firm, says that coverage for complementary and alternative medical treatments hasn't grown to the extent that it should. "Eastern medicine has been around longer than western medicine," he says.

Coverage also varies widely from state to state, says Wurzel. New York, for example, is "at least 30 years behind California," he says, adding that benefits for alternative therapies get substantially better the farther south you move. "Costs are prohibitive in New York," he explains. "Anything you add on to a policy here will get used by a large number of people, and those costs aren't cheap."

"Insurance companies are not altruistic organizations," says Wurzel. "They're profit centers."

Still, things are changing, if for no other reason than consumers are demanding it. "We're now seeing consumer-driven healthcare," says Ken Linde, president and CEO of Destiny Health, an insurance carrier headquartered in Oakbrook, Ill., that also offers discounted rates on CAM therapies. "Consumers want to be in charge of their own destiny."

If you are interested in seeking complementary or alternative therapies, do your homework first, says Rhonda Allenson, vice president of case management services for Managed Care Resolutions, a New York-based consumer advocate company that assists patients with healthcare disputes.

Read your coverage booklet, says Allenson. Before you receive services, make sure the treatment you're investigating is covered, and make sure the provider is covered as well.

If they are covered, find out whether you need preauthorization. If so, get the authorization number and "document everything," says Allenson.

"Be proactive," she says. "Don't assume that things are taken care of on the other end."

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Last Editorial Review: 1/31/2005 4:34:24 AM



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