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Health Insurance: Coverage for Complementary and Alternative Medicine Posted: September 6th, 2010

By April Dykman

Health Insurance: Coverage for Complementary and Alternative Medicine

Insurance companies are beginning to see what holistic health practitioners have know for years--sometimes the best medicine isn't a prescription from the corner drugstore. In a Yoga + Joyful Living article, Timothy McCall, M.D., wrote about how the distinction between conventional medicine and complementary and alternative medicine (CAM) is for the most part arbitrary. "How else could you explain why aspirin, a drug originally derived from willow tree bark, is considered a conventional medical treatment for pain relief, while willow tree bark itself is alternative?" he writes.

But when it comes to health insurance, the distinction between conventional and CAM can hit you right in the pocketbook. According to the National Center for Complementary and Alternative Medicine (NCCAM), those who seek out CAM services and products typically pay out-of-pocket. Individuals with medical insurance often find that their plan doesn't cover all, or any, of their CAM therapies.

Findings from the 2007 National Health Interview Survey (NHIS) showed that adults spent an estimated $33.9 billion out-of-pocket on CAM treatments during the previous 12 months, with $11.9 billion of that spent on visits to CAM practitioners. That's a sizable chunk of health care expenditures, with out-of-pocket expenditures on CAM treatments accounting for 11.2 percent of out-of-pocket health care expenditures in the U.S.

Coverage for CAM treatment

Many insurance companies are starting to cover acupuncture and chiropractic care, at least in part. Employer-sponsored health plans are most likely to cover CAM treatments, though according to NCCAM, you might pay a higher deductible or copay. Another option offered by some employees is a CAM rider that can be added to the standard insurance policy.

How to get reimbursed for CAM therapy expenses

If you're considering a CAM treatment or product, start by reading your health insurance policy to find out if the therapies you want to try are covered. NCCAM suggests calling your insurer before you seek treatment and asking the following:

  • Does the policy cover the CAM treatment for my particular health condition?
  • Do I need pre-authorization or pre-approval for the treatment?
  • Will I need to provide a referral from my primary care physician to get the treatment covered?
  • Does my policy require that I see someone in a network?
  • If I see someone out of the network, is any of the cost of treatment covered?
  • Are there restrictions on how many visits or limits on the dollar amount the policy will pay out?
  • What will I need to pay for out-of-pocket?

If your policy won't cover the treatment, it doesn't hurt to stay on your insurance provider about it. A recent New York Times article offered the following tips to maximize your coverage:

  • Don't assume the first denial is the final word. Sometimes it takes a few claims to get coverage.
  • Work with your case or claims manager to negotiate between insurer and provider.
  • Don't go it alone. Many hospitals have a patient advocate that can help you manage the mountains of paperwork, and it's especially important to get help when dealing with a serious illness.

NCCAM also recommends keeping detailed records on interactions with your insurance company. It's your best line of defense should you have problems with your claim. It can be confusing and complicated to navigate the insurance world, but stick with it and explore all of your options to get reimbursed for the CAM treatment you need.