The cost of healthcare in the US is an issue that continues to rise with little sign of relief for many struggling with low incomes and expensive health insurance coverage. In an ideal world, any necessary treatment would be affordable and accessible to all.
In most cases a typical health insurance plan covers traditional methods of Western medication, surgery, and other procedures. Those struggling financially can receive help with premium costs, prescriptions, and other medical expenses. However, it isn’t quite so straightforward when it comes to alternative medicine coverage.
In this guide, we will look at some of the key issues in this confusing situation.
Why is it the case that insurers cover some conventional treatments, but not other, equally beneficial alternative options?
Is there is a clear list of methods that aren’t recognized, or does it vary?
We will look at the problems involved in claiming for complimentary, alternative procedures as well as some of the solutions available. There is no reason to give up hope of affording an alternative treatment just because it does not comes under coverage.
Why Are Some Treatment Options Covered While Others Are Not?
Many of us would assume that there would be some sense of uniformity in the rules with alternative therapy and health insurance. The problem is that are lots of variations between plans. There is no black and white line splitting conventional and alternative measures neatly in half.
Some use the following rules to determine the legitimacy of a claim. They only cover a treatment deemed medically necessary and they only cover those supported by scientific and medical evidence. This is a problem for those patients trying new approaches where conventional medicine either failed or did not produce the desired effect.
The easiest way to claim for health insurance payouts is to provide a prescription or other written statement from a doctor for a clear course of action. These referrals are difficult to refute. The problem is that many try alternative treatments off their research without the advice or referral of a recognized practitioner. This means that it’s hard to create a clear list of treatment options and approaches covered.
(Source: Kenny Tims)
Some forms of alternative therapy crossed over into the mainstream and an accepted form of health care. These approaches carry a higher chance of acceptance because practitioners offer them with referrals from medical professionals, or have the scientific backing required. The following are key examples. Even some of these come with caveats.
Acupuncture still has its detractors, but acceptance and referrals are on the rise. Generally speaking, insurance coverage requires a diagnosis of a specific condition to treat, where there is a clear link between illness and cure. Chronic pain and migraines are great examples. There is also often a cap of 12 to 20 visits a year under insurance. This is encouraging to many that once struggled to afford this option when it had a less impressive reputation. 20 visits per year under insurance could make a massive difference.
This is another area where doctors and medical professionals were once reluctant to refer patients, or even admit that it was an option. There was the sense that it was a quick focus with minimal benefits and high costs over long session plans. However, there are many people with back, neck and other skeletal issues that swear by it.
Understandably, they want to see these sessions covered under their insurance. The general rule here is that 15 to 25 sessions are eligible for coverage by insurers. Patients must pay the rest themselves. This may not be enough in all cases, but it is a vast improvement.
Biofeedback is an interesting alternative approach that many patients may not have heard of. This is an issue when looking for the best approach for a condition as it may not be immediately accessible. This is particularly the case if doctors decide not to make referrals.
The idea is that practitioners hook users up to sensors for heart and breathing rates and guide them through breathing exercises, relaxation techniques, and guided imagery. This is still new and uncertain for many insurers so that typical health insurance packages won’t cover it. However, some plans will cover the system if it is a diagnostic tool for issues like headaches or fibromyalgia.
Naturopathy is a discipline that is currently gaining some moment in the alternative medicine world. The idea here is that providers help with more general issues of wellness and disease through a combination of approaches. These include herbal remedies, acupuncture, dietary advice and other lifestyle changes.
This is an excellent example of one of those alternative options on the cusp of big change. At the moment, most plans won’t consider paying out for this sort of treatment. However, there are some states where providers have changed their minds.
Then we have a rather generalized list of things that are not covered by Health Insurance. The options above are all considered because of the potential for scientific and medical progress for a clear medical issue. There are plenty of other treatments and complimentary options designed to provide support and relief that do not fit into this category. Examples include music therapy, aromatherapy, and therapeutic touch massage.
Again, the issue of options that are not covered is not black and white. Patients have to remember that any assumptions that they make about the legitimacy of an alternative method may not be true. Some that may appear to be unusual and off the radar may be eligible for coverage under the right condition.
Also, while the Affordable Care Act should ensure that insurers cannot discriminate against licensed alternative medicine practitioners, this doesn’t apply to coverage. For example, naturopaths, acupuncturists, and music therapists all deserve the same chance to practice their methods, but there is no legal right to health insurance in all circumstances.
The best way to be sure of accurate coverage is to speak with the provider about a case.
Any patient with a specific issue or condition with a specific line of alternative treatment should talk to their provider upfront. These consultations can clear the air about all the gray areas and red tape that may obstruct the way forward. They can provide clear answers to what they will and will not cover for you based on the condition, doctor’s report and local options.
This is crucial as the answer may not be what you expect. For example, patients with fibromyalgia get coverage on therapeutic massage, but not acupuncture and energy work. Many would assume acupuncture was the most likely there.
This is also the perfect time to go deeper in the clear terms and conditions, and limitations, on a plan. The need for referrals or prescriptions from a conventional practitioner is just the start. There is also the issue of deductibles and co-pays, limitations on the number of visits and limitations on the companies linked to the provider.
The Problem Of Additional Costs Supplements And Packages Where The Coverage No Longer Applies Or Only Half Applies
There will be cases where insurers will provide coverage for these alternative treatments, but only at the most basic level. You can sign up for a course of sessions within the time frame agreed, but what happens if the provider recommends additional supplements.
There is a choice here. Either refuse the additional help because of the costs, or budget for these additional extra if they will prove to be of worth. Again this highlights the importance in discussing every aspect of the treatment before signing up.
Get A Receipt To Improve Your Chances Of A Claim
This is great advice for all patients no matter the situation. A receipt of treatments and costs provides clear evidence of precisely what they offered and how much to claim for. It adds some legitimacy to the alternative solution that may sway an insurance provider. Some will use this receipt to your advantage. Others will require more persuasion.
It might help to use codes that insurers understand for better communication on the subject. These ICD and CPT codes refer to the International Classification of Diseases and Current Procedural Terminology codes. These five-digit numbers are commonly assigned to specific treatments and universal.
What Happens If You Want A Treatment That Isn’t Covered?
So far we have looked at two scenarios. They are the growing list of treatments covered when we would expect otherwise, and the methods to get insurers to agree on coverage. These factors show that there is hope for more affordable health care with the right approach and right treatment option. However, it is also clear that there are times when these methods won’t work. So, what do we do when our insurance providers say no?
The first option is to give up and stick with the methods covered. The problem here is that it is difficult when there are potentially better options out there. The next is to cut your losses, find the funds and pay out for the full treatment in the hope that it works. The other option is to start negotiating for a better deal.
Discussing Options With Practitioners For Payment Plans
Remember that it is unlikely that only one provider can offer a specific treatment in your local area. There are sure to be competitors with different price structures, bonuses, and other incentives. This can create a sense of competition between providers to become the best in the area. This means that negotiations on price plans and other benefits may work if therapists think they are losing a customer to a rival.
Take the time to discuss a clear schedule of sessions and payments, as well as additional fees. It may not be a lot cheaper in the long run, but it will lessen the burden in shorter installments. There are also other ways to pay for some expenses and prescriptions for these clinics, so discuss these options too. For example, patients with FSAs can set aside a specific amount of pretax cash for health care expenses within that year. Users can spend this on the treatment, extra fee or even travel expenses to the facility.
Don’t Forget About The Potential For Discounts With Trainees
The other way of lowering the overall costs of an alternative therapy treatment session is to head to a training center or college.
Students need plenty of willing people to practice their skills on for effective therapy. They may as well learn from you if you are willing. One example is the Pacific College of Oriental Medicine in Chicago, New York, and San Diego. They offer acupuncture and herbal medicine consultations for a discounted price.
There are clear advantages here, as the costs are greatly reduced for those looking to test out an alternative approach to a major problem. However, this isn’t ideal for long-term sessions, and there is the risk that it won’t be perfectly executed compared to professionals.
What To Consider For The Right Approach To Your Treatment Plan
Some may assume that their preferred treatment option is out of the question because there is no referral or the method is questionable. However, these tricks with the receipts, payment plans and alternative providers offer some hope. It pays to take the time to research options and cost to play the system to your advantage. If a company needs proof of prescription and medical need, ask a doctor to help out and research the appropriate CPT codes. If they still don’t help, find providers that will.
There are some clear loopholes and alternative approach for those keen on a way forward and affordable care. This is one of the benefits of a system with so many gray areas. There are downsides in this, as it can be difficult to keep up with local attitudes to therapeutic measures or the methods available.
There are choices and second chances for those willing to dig around. In the end, the most important factor here is the illness and the treatment method best suited to provide relief and possible treatment. There is no need to give up on the perfect approach just because insurers initially say no.