Alternative Medicine: Is It Covered?

By David Levine

October 20, 2020

IT’S STILL KNOWN AS alternative medicine, but services like chiropractic care, acupuncture and therapeutic massage are not that alternative anymore. According to the National Center for Complementary and Integrative Health, almost 40% of adults and 12% of children use complementary or alternative medicine, or CAM, to stay healthy and treat chronic or severe conditions.

Many more would likely use some kind of complementary or alternative treatment if it were covered by their insurance company. While many carriers cover a few services under certain circumstances, most CAM treatments are not covered, forcing patients to pay for it out of their own pocket.

Data from a 2016 study led by the NCCIH suggest that Americans are more and more willing to pay those out-of-pocket charges. Between 2002 and 2012, those who saw a chiropractor rose from 7.5% to 8.3%. The numbers were 1.1% to 1.5% for acupuncture and 5% to 6.9% for massage. Interestingly, usage rates stayed the same for those who had at least some insurance covering the care, but they went up among those who lacked coverage.

For those looking to have complementary or alternative treatments covered, here is what you should know.

CAM Coverage Varies

The NCCIH says that Americans spend about $30.2 billion each year out-of-pocket on complementary health products and practices beyond what their insurance covers. This includes:

• $14.7 billion for visits to such practitioners as chiropractors, acupuncturists and massage therapists. 
• $12.8 billion on natural products.
• About $2.7 billion on self-care approaches, including homeopathic medicines and self-help materials, such as books or CDs, related to complementary health topics.

The 2016 study found that 60% of the respondents who had chiropractic care had at least some insurance coverage for it in 2012, but those rates were much lower for acupuncture (25%) and massage (15%). Partial insurance coverage was more common than complete coverage. For chiropractic, nearly 40% of respondents had no coverage, 41.4% had partial and 18.7% had complete coverage. For acupuncture, the breakdown was 75%, 16.5% and 8.55%, and for massage, it was 84.7%, 8.35% and 7%.

The NCCIH says the following complementary or alternative treatments are most often covered to some degree:

• Chiropractic: 91% of big insurance companies cover prescribed chiropractic care, most limited to between 15 to 25 prescribed visits with a $20 to $30 copay.
• Acupuncture: 32% of big insurance firms cover acupuncture, usually limited to about 20 visits annually.
• Massage: Roughly 17% of large insurance firms cover massage therapy, typically if physical therapy and medication hasn't helped.
• Homeopathy: Only 11% of major insurers cover homeopathic remedies.
• Hypnosis: Insurers that cover hypnosis require physician authorization, and they typically cover only 50% to 70% of costs.
• Biofeedback: Only a few insurers cover the mind-body technique biofeedback, and when they do it's only for a documented condition like migraines or fibromyalgia.
• Naturopathy: Insurers are more likely to cover a licensed naturopath, but only 19 states have such licensure.

Those are averages, of course, and some plans cover a lot more than others. The Capital District Physicians' Health Plan, a regional carrier in upstate New York, for example, offers coverage or reimbursement options for things like fitness classes, smoking cessation, lactation consults, yoga and nutrition classes. The plan is exploring offering other potential benefits such as massage therapy, family health and caregiver support and offerings to address emotional resiliency and social isolation, says Mike Spicer, director of product innovation and research for CDPHP.

What determines which services get covered? “Some CAM treatments are viewed as unproven or unsafe in some cases, or experimental or investigational,” Spicer says. At CDPHP and most other plans, a team of clinical experts reviews which services meet their requirements for safety and effectiveness before offering coverage.

Shopping for CAM Coverage

The NCCIH says that those who would like to use CAM services should contact their health insurance provider and ask the following:

• Is this service covered for my health condition?
• Does it need to be preauthorized, preapproved or ordered by a prescription?
• Do I need a referral?
• Does coverage require seeing a practitioner in the network?
• Do I have coverage if I go out-of-network?
• Are there any limits and requirements – for example, on the number of visits or the amount you will pay?
• How much do I have to pay out-of-pocket?

You can also request a standardized Summary of Benefits and Coverage, or SBC, from the plan, which lists whether other services like chiropractic and acupuncture are covered. “Insurers and employers must offer an SBC to any enrollee or potential enrollee on demand, and most are posted online – for example, on the marketplace website,” says Karen Pollitz, a senior fellow with the Kaiser Family Foundation. “People interested in these benefits might start with the SBC to see if they’re listed under ‘other covered services,’ but probably would have to contact the insurer for more details about the coverage.”

Your state’s insurance department also may be able to help you find out which insurance companies cover specific CAM approaches. USA.gov provides contact information for state and local consumer agencies, including insurance regulators. Finally, professional associations for CAM specialties, such as the American Chiropractic Association or the Acupuncture Foundation Professional Association, often track insurance coverage and reimbursement trends in their field. The NCCIH suggests you contact a reference librarian for help finding them, or search for them on the internet.

When it’s time to shop for a new plan, Spicer says, “Seek out a plan and insurance coverage that cares about you as a member, not only in times of sickness, but also in times of health. Not all health coverage is the same, and shopping around for a carrier that treats you like family can make all the difference.”

HSA or FSA Options

If your plan doesn’t cover some or all of your CAM treatment, ask your employer about using a health savings account or flexible spending arrangement. These accounts take money pretax from your salary, which can be used on alternative care including:

• Acupuncture.
• Aromatherapy.
• Ayurvedic medicine.
• Homeopathy.
• Nutritional consulting.
• Traditional Chinese medicine.

The NCCIH says HSAs and FSAs are common with high-deductible plans, but you may need a letter of medical necessity from a doctor to cover alternative treatments with one of these accounts.

Any questions? We have agents available to assist you with your insurance needs!

Mike Desnoyers

(312) 283-1807

mike@ihealthagents.com