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Insurance For Holistic Health? Here's What's Covered

By Kathy Summers

If you’re like 62 percent of Americans, you use some form of complementary and alternative medicine (CAM), according to the National Center for Complementary and Alternative Medicine (NCCAM). In fact, a Harvard Medical School survey says Americans make about 425 million visits a year to holistic providers. But do you know which of those visits your health insurance policy covers?

“Virtually every insurance carrier offers some form of CAM coverage — Blue Cross and Blue Shield, Aetna, Cigna, Healthnet — all of them,” says Kenneth R. Pelletier, Ph.D., M.D., author of The Best Alternative Medicine: What Works? What Does Not? (Simon & Schuster, 2002).

“It’s a very clear trend — once they begin to offer CAM benefits, most companies tend to continue and expand and add on other services,” says Pelletier. Of course, not all CAM benefits are realistic or accessible.

Some health plans cover acupuncture, traditional Chinese medicine, and homeopathy (provided by a licensed physician) while others offer only chiropractic care. “It’s interesting how chiropractic started out alternative, then became complementary, and is now mainstream,” says Ted Wise, Kaiser Permanente's senior vice president of health plan strategy and product innovation.

Some health plans that offer few real CAM benefits offer CAM discount plans and member education programs. Kaiser Permanente offers programs for yoga, meditation and tai chi, but Wise says these programs are just extras and are not intended to supplant benefit offerings. “We wanted to offer CAM to all our members without having to go through each employer’s decision of whether to carry the benefit or not,” Wise explains.

More and more employer groups self-fund their employee health plan, which allows them to choose the benefits they carry. That’s good or bad news, depending on your employer’s pockets and point of view.

“Many employers want to attract and retain the best employee, and, certainly, rounding out the benefit plan with chiropractic, acupuncture, massage and dietary counseling is a positive thing to offer,” says George DeVries, CEO of American Specialty Health in San Diego. “Unfortunately, the rapidly escalating cost of health care overall is working against the industry right now.”

Alternative benefits vary from plan to plan and from state to state. Here’s how to evaluate your plan and get the most out of the alternative benefits available to you:

w Call your health plan, or talk to your human resources representative, to find out what alternative benefits they cover. If your employer self-funds the policy, lobby for more CAM benefits. It might help if you can tie a specific benefit to fewer sick days and better performance at work.

w Find out what it takes to access benefits. Some health plans allow direct access to participating chiropractors, acupuncturists, massage therapists, naturopaths and dietitians. Others require a medical referral from a primary care physician. If it’s the latter, “You need to carefully choose your primary care physician if you also want to work with alternative practitioners,” says Pelletier.

w Vet the network. Go to your health plan’s website for a list of participating alternative providers in your area, or ask your coworkers which providers they like. “Call two or three to see which one meets your needs,” says DeVries, “and if you’re not completely satisfied, choose a different participating provider.” Some plans offer full or partial coverage for practitioners who are not part of the network.

w Factor in co-pays. Some policies have the same co-pay for CAM as for conventional medicine, but not always. “You may have a zero co-pay, a $10 co-pay, or a $20 or higher co-pay per visit,” says Devries.

w Ask about limits. “Limits are decided by the payer — either the health plan or your employer,” DeVries explains. “You could have a 10-visit limit, a 40-visit limit or no limit.” Also, a health plan may cover a particular alternative therapy for some conditions but not for others. “Massage will typically only be covered for neuromuscular conditions — for example, low back pain,” says Devries. “And we cover naturopathy only in states where naturopaths are licensed, such as in Oregon and Washington.”

w Check the deductible. “Sometimes, when you consider the deductible and the co-pay, along with the limited number of visits allowed, you find it’s cheaper in the long run to just pay in cash,” says Pelletier.

w Ask about a supplemental CAM rider. An insurance rider provides additional coverage for something not specifically covered on your primary policy. You’ll have to pay an extra fee to have CAM benefits added to your policy, but if you use alternative therapies often, it may just be worth it.

--Kathy Summers is a health, fitness and nutrition writer in Cave Creek, AZ.