How to Get Your Medical Insurer to Cover Alternative Medicine Treatments
Insurance companies often consider therapies from massage to herbal supplements outside the medical mainstream. Here’s how to get reimbursed.
Although it may seem obvious that acupuncture helps relieve, say, your chronic back pain, insurance companies often consider such therapiesfrom massage to herbal supplementsoutside the medical mainstream. They are, after all, still referred to as complementary and alternative medicine (CAM). However, many insurers do cover selected therapies on a case-by-case basis, depending on the way you request reimbursement.
“If you talk to insurance people, they quote you by the book and say massage is not covered. Yet, I would say one-third of our Blue Cross Blue Shield patients are getting some reimbursement,” says Paul Rubin, a chiropractic physician at WholeHealth Chicago, a medical center that integrates traditional and alternative medicine. And even if your insurance company refuses to cover alternative treatments, there are ways you can reduce your out-of-pocket expenses.
The best way to get reluctant insurers to cover alternative therapies is by making a good case that your treatment is medically necessary. The simplest way to do this is to get a prescription. Ask your primary care doctor to write one that includes the diagnosis and the frequency and length of treatment. Although they may not advertise the fact, some insurers will rubber-stamp CAM treatments if they are prescribed by a physician. Some of the most frequently covered therapies include chiropractic care, massage therapy, acupuncture, herbal remedies, homeopathy, and mind-body stress management.
One of Rubins patients, a woman in her mid-50s, came to his office with fibromyalgia; she had chronic pain and fatigue. She was treated by an internist, who prescribed the pain medication Lyrica, and she also saw an energy healer, an acupuncturist, and a massage therapist on staff. WholeHealth Chicago submitted a detailed claim to the insurer that included a prescription for the CAM treatments and receipts that used standard diagnostic and treatment codes. Her insurance paid for the internist and therapeutic massage, says Rubin, although the acupuncture and energy work were denied.
Another strategy is to convince the insurance company that covering alternative treatments may save them money in the long run. Some conventional treatments for chronic back pain, for instance, cost far more (and in some cases may be less effective) than alternative options such as acupuncture and biofeedback. "To a certain extent, its playing the insurance game," says Rubin. "I would never ask anyone to not tell the truth, but if you can make the case clearly that what is being done is clinically necessary as an alternative to pharmaceuticals or surgical procedures, the insurance company can see, 'Gee, this treatment is $200, while medication would be $600 and surgery would be $10,000.'"
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