What kind of help can you expect from your insurer?
May 15, 2000 -- I've tried everything for allergies and asthma. Well, almost everything. I refuse to get rid of my beloved St. Bernard, and I won't move away from my dust-blown neighborhood. As a result, I have spent days at a time holding tissues to my nose, coughing into the phone, and grabbing my inhaler like a lifeline. I've been on hiking trips where I had to stop high atop a mountain, gasping for air, hours away from emergency medical care. And I've often awakened at night frightened and unable to breathe. Nothing my doctor offered eased my symptoms reliably. Before I resorted to getting injections -- a last-ditch treatment -- I decided to try some therapies that I hoped would get to the root of my overactive immune system: herbs and acupuncture.
So lately I've been making regular visits to an acupuncturist and brewing up medicinal teas. There's no guarantee that my offbeat approach will work, but so far the signs are good. I no longer fumble for an inhaler at 4 in the morning -- and today I even forgot where I left the box of tissues. Unfortunately, when it comes to finances, I'm pretty much on my own. My insurer referred me to an acupuncturist who agreed to a discount rate. But the help stops there.
As consumers like me flock to alternative treatments, however, more and more insurance companies are offering at least some assistance. Some major health plans select a few therapies, typically chiropractic and acupuncture, to offer as core benefits. Unfortunately, coverage still tends to be spotty. Still, even if your insurer isn't one of those offering regular coverage, insurance experts say there are some little-known strategies you can use to boost your chances of getting helpful alternatives covered.
A Sea Change
Ten years ago, the notion that mainstream insurance companies would be paying for things like acupuncture would have seemed unthinkable. But consumer interest in complementary medicine, together with increasing scientific evidence of its effectiveness, have spurred big changes.
Four out of ten Americans used alternative therapies at least once in 1997, spending a total of $21.2 billion on such treatments, according to a study published in the November 11, 1998 issue of the Journal of the American Medical Association. According to recent surveys, as many as 90% of employer-paid plans cover chiropractic care and about 30% offer acupuncture, says John Weeks, publisher of an industry newsletter called The Integrator for the Business of Alternative Medicine. In Washington state, a recently upheld law gives health insurers no choice but to pay for the services of about two dozen types of licensed alternative providers, including naturopaths, massage therapists, and acupuncturists.
Still, most big insurers, including Aetna and U.S. Healthcare, have only dipped their toes in alternative waters. Like my insurer, they're setting up "affinity programs" that provide discounts to a network of affiliated providers.
Many insurance companies hesitate to jump all the way in because they don't know just how much these treatments will cost over time. While they certainly hope the preventive thrust of alternative care will save them money, most don't have a clue, says Lee Launer, a partner at Price Waterhouse Coopers in New York. "What is the cost structure?" asks Launer, who is working on a cost analysis for the Society of Actuaries. "We don't know. Do you spend less to get more care? Or more?"
What You Can Do for Yourself
Of course, most consumers are more interested in their own pocketbooks than health care costs for the nation at large. If you're convinced an alternative therapy is right for you, Weeks and other experts offer these tips to help you get coverage:
- Talk to your human resources or employee benefits managers and tell them what you want. You might put together a simple survey and ask others in your workplace whether they want alternative benefits, too. You could even suggest a plan to measure usage and outcomes. Write to the president of your health plan as well.
- Collaborate with your doctor and ask her to include the alternatives you'd like to try in her treatment plan. Many doctors are surprisingly open to options that their patients suggest. If your regular physician recommends an alternative therapy as part of medically necessary care, some health plans will pay for them.
A few major insurers, including Mutual of Omaha and Aetna, may pay for therapies not covered in a plan if you can provide scientific evidence -- articles from respected medical journals, for instance -- that they are helpful. If your insurer refuses coverage, try getting a second opinion. A sheaf of physician recommendations, followed by a letter-writing campaign, may help.
- If you have to pay out of your own pocket, ease the pain a bit by using tax-sheltered money. Many employers offer a flexible spending account that allows workers to set aside tax-free money for medical expenses. Ask your employer for specifics. Also check with the Internal Revenue Service: Only certain alternatives, such as chiropractic and acupuncture, qualify as legitimate deductions.
Pressure from consumers, leading to pressure from employers, definitely makes a difference, says Richard Coorsch, spokesman for the Insurance Association of America. "If there is demand, insurers will write policies," he says. "You're seeing more of it."
Because I'm self-employed, the only person I can pressure is myself. But since I'm feeling so much better, I'm counting on big savings on the costs of prescription co-payments and facial tissues.
Sally Lehrman is a freelance writer based in San Francisco who specializes in medical technology and health issues. Her work has appeared in Health, Nature, GeneSage.com, and other publications and web sites.
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