How to Get Your Medical Insurer to Cover Alternative Medicine Treatments
IstockphotoMore insurers are covering alternative therapies like acupuncture.
By Jeanne Lee
Although it may seem obvious that acupuncture helps relieve, say, your chronic back pain, insurance companies often consider such therapies—from massage to herbal supplements—outside 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.'"
Next Page: Get a receipt [ pagebreak ]
Get a receipt
Even if you cant get a prescription from a physician, you should get a detailed receipt whenever you pay out-of-pocket for an alternative treatment. This will increase your chances of being reimbursed. "The receipt should include more than 'XYZ Acupuncturist, $65,'" Rubin advises. “You need to put it in the insurance companys language, which is ICD and CPT codes.” The International Classification of Diseases (ICD) is an internationally standardized system of codes for medical diagnoses, while Current Procedural Terminology (CPT) codes are five-digit numbers assigned to specific treatments by the American Medical Association (AMA) in order to facilitate communication between (and among) medical specialists and insurers. CPT codes exist for alternative treatments such as acupuncture, therapeutic massage, and biofeedback, and you can search for other codes by keyword on the AMAs website.
In addition to the official diagnosis and CPT codes, ask the practitioner to outline the treatment plan (the duration and frequency of visits, for example). If you do have a prescription, make sure the treatment on the receipt falls within the plan that was prescribed. Indeed, when you are choosing a practitioner, its always a good idea to ask if they have experience submitting insurance claims for alternative therapies.
If your insurance claim for an alternative treatment is denied, try appealing the decision. Sometimes the insurer can be convinced with additional documentation, such as medical notes from the CAM practitioner. “The carriers dont want to spend their money unless its helping,” says Jennifer Gibbons, the office manager at Wall Street Physical Medicine & Rehabilitation, a New York City facility that offers acupuncture and therapeutic massage, among other treatments. “They want to see improvement. They want medical notes that show that pain has gotten better, or that impediments to acts of daily living—such as not being able to put on your shirt because you have a frozen shoulder—are improving.”
Limiting out-of-pocket expenses
If you have to pay your own way for all or part of your treatment, you should explain your circumstances to the CAM practitioner. “It is always beneficial if the patient discusses the financial issues with the practitioner prior to the first appointment,” says Janet Borges, a licensed acupuncturist and spokesperson for the American Association of Acupuncture Oriental Medicine. “Often they will negotiate a fee for service that may be even more beneficial for both parties than insurance coverage, such as a sliding-scale fee structure.”
You may also be able to save on CAM treatments by using pretax money from a health savings account (HSA) or flexible spending arrangement (FSA). If you have a high deductible health plan ($1,100 or more), sometimes known as a “catastrophic” insurance plan, you are probably eligible to open a tax-free health savings account (HSA). As with an IRA, contributions to HSAs are tax-deductible and the money is tax-exempt upon withdrawal if used for a qualified health expense. Offered by many employers, FSAs allow you to set aside an annual amount of pretax dollars for health care that must be used by year's end. Depending on your tax bracket, the tax savings from these vehicles can add up to a substantial discount on treatments. Eligible expenses may include therapeutic massage, acupuncture, and more (check your plans language for details). Even travel expenses—such as bus, taxi, and train fare—that are used primarily to get to essential medical care are eligible.
Next Page: Discount treatments [ pagebreak ]
If all else fails, you may be able to find affordable treatment in your area. Alternative medicine colleges often offer treatment from students or interns at reduced rates. The Pacific College of Oriental Medicine, for example, has clinics in Chicago, New York, and San Diego, where you can receive acupuncture treatment or herbal medicine consultations for a fee ranging from $10 to $60. Similarly, the National College for Natural Medicine in Portland, Ore., which offers graduate professional degrees in naturopathic medicine, oriental medicine, and acupuncture, has 11 community clinics offering free or low-cost medical care by naturopathic physicians in and around the Portland area.
For affordable acupuncture, try what is known as a community acupuncture center, where treatments are usually offered on a sliding scale ranging from $15 to $40. Patients often receive treatment while sitting in recliners in a shared room. “The community acupuncture model is an option offered primarily to low-income or underserved populations,” says Borges.