IQ expert Jason Beans: Getting your health insurance plan to cover alternative treatments

Q: Are alternative or non-Western treatments (chiropractic, acupuncture, Chinese medicine) covered by some health insurers but not others? Why or why not?

A: You’re talking about contemporary and alternative medicine (CAM), whose use has been on the rise in the past decade. These alternative therapies, as opposed to traditional medicine, include acupuncture, chiropractic care, massage, energy healing, hypnosis, biofeedback, meditation, prayer and spiritual healing.

Americans spend $33.9 billion out of pocket on CAM annually, according to the National Center for Health Statistics. While that number represents just 1.5 percent of our total health care picture, it equates to a large portion (11.2 percent) of out-of-pocket spending. I argue that we’re better off keeping alternative medicines an out-of-pocket expenditure.

About 38 percent of Americans use CAM in one form or another, according to a survey by the federal Centers for Disease Control and Prevention. Yet despite our population’s usage of CAM, some insurance companies are reluctant to cover such treatment, claiming there’s no proof of effectiveness or safety. Medicare and Medicaid don’t yet cover these alternative treatments. More and more insurance companies, however, are covering certain alternative treatments like acupuncture, massage and chiropractic care.

And while some insurance companies may not fully cover a treatment like acupuncture, they may have what’s called an “affinity program” that offers discounts for going to specific acupuncturists. Similarly, other therapies (such as homeopathy, biofeedback and yoga) may not be included fully but are available at a discount through you insurer.

While it may sound like a good idea to have your health insurance cover acupuncture, for instance, be careful of what you wish for.  I actually prefer the way the system currently functions. You, the consumer, have many options and have the power to choose where you want to spend your money based on quality and price. Paying out of pocket for these alternative therapies keeps them more affordable. The minute we get the major medical plans involved, prices increase. For instance, I have paid $40 out of pocket for an acupuncture visit. When acupuncture is billed through a carrier, it can cost $200 a visit — five times what I paid out of pocket for the same service and same practitioner.

Currently, the way the system works, the ball is in your court. If you want to pay out of pocket, you can. If your health insurance company covers these types of treatments, you certainly can have your insurer pay for them. If they don’t cover them, you can state your case and try to get them covered.

Remember, however, that this ultimately isn’t about getting your insurance company to cover your treatments; it’s about which path leads to less spending on your part. Price things out before you decide you want to get your health insurance plan involved; that way, you can decide whether it even makes sense to do anything beyond paying out of pocket.

Here are the seven steps you should follow:

1. Read the fine print in your health insurance plan to see what is covered under “alternative treatments.” If your insurance covers certain treatments, make sure you understand the details. How many treatments can you get? How does your insurance company pay? Who must provide the treatments? Do you need a referral from a physician? Is this alternative treatment covered based on specific conditions?

2. Call your health insurance provider to see whether your visits to an alternative therapy practitioner will be covered. If there’s something you’d like to have covered but your insurance won’t, ask why. If the company responds that there’s no evidence that such a treatment works, then start researching on your own to find proof. Provide your health insurance company with your findings and see whether the insurer will change its mind.

3. Get authorization from your health care provider stating that you’ve been referred to an alternative practitioner.

4. File a claim if you received alternative treatments without authorization from your provider.

5. Write a letter to your insurer and to your employer’s benefits officer requesting coverage. You can ask your co-workers to do the same. Many insurers base their coverage options on perceived demand. The results of your labor may not happen right away, but could come to fruition down the road.

6. If your health insurance provider won’t change its mind, consider switching to catastrophic or high-deductible coverage. It’s much less expensive, and the money you save can go toward your choice of alternative treatments.

7. Comparison shop. If you can’t get your alternative treatments covered by insurance, you still can save money. Unlike traditional medicine, alternative medicine allows you to pick a provider based on price. Use this to your advantage and shop wisely.

Jason Beans is CEO of Chicago-based Rising Medical Solutions, a medical cost containment/care management company serving the workers’ compensation, group health, auto and liability markets. Beans founded Rising in 1999. Since then, Beans has received a number of honors, including Business Council Advisory Man of the Year and Midwest finalist for Ernst & Young Entrepreneur of the Year. Rising has appeared several times on the Private Company Index’s Top 10 Growth list and Inc. magazine’s Inc. 5000 list.

Beans earned a master’s degree from MIT’s Entrepreneurial Masters Program and a bachelor’s degree in finance from Boston College.

For more information, visit www.risingms.com.

If you have a health insurance question for Jason Beans, please send it to john.egan@insurancequotes.com.