Does Your Health Insurance Cover Alternative Medicine

https://health.usnews.com/health-care/health-insurance/articles/alternative-medicine-health-insurance

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.

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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.”

Be Sure to Attend “The Pasta Is On Us” Presentation on October 25, 2016

If you haven’t already reserved your seat, there is still time!

Join us for a Pasta Extravaganza at the Old Spaghetti Factory

“THE PASTA IS ON US”

6:30 pm

October 25, 2016

You heard us right!

Bring along a friend or loved one who desperately needs to hear about nonsurgical spinal decompression and we’ll treat you both to dinner!

If you or someone you know has been told to have back surgery

If you or someone you know has had back surgery and still have pain

If you’ve been looking for a treatment that will let you take back your life once and for all

Then you owe it to yourself to bring your questions and curiosity to the Old Spaghetti Factory on Tuesday, October 25, 2016 at 6:30 pm and meet Dr. Jeffrey K. Tunick and Dr. Thomas Grace

Dr. Tunick and Dr. Grace are exciting and informative speakers who will truly listen to your questions and concerns and provide the answers you have been seeking all along

Call the clinic and register today

503-684-9698

Seats are limited so don’t wait till the last minute!

Join Us for a Pasta Extravaganza at the Old Spaghetti Factory

Join us for a Pasta Extravaganza at the Old Spaghetti Factory

“THE PASTA IS ON US”

6:30 pm

October 25, 2016

You heard us right!

Bring along a friend or loved one who desperately needs to hear about nonsurgical spinal decompression and we’ll treat you both to dinner!

If you or someone you know has been told to have back surgery

If you or someone you know has had back surgery and still have pain

If you’ve been looking for a treatment that will let you take back your life once and for all

Then you owe it to yourself to bring your questions and curiosity to the Old Spaghetti Factory on Tuesday, October 25, 2016 at 6:30 pm and meet Dr. Jeffrey K. Tunick and Dr. Thomas Grace

Dr. Tunick and Dr. Grace are exciting and informative speakers who will truly listen to your questions and concerns and provide the answers you have been seeking all along

Call the clinic and register today

503-684-9698

Seats are limited so don’t wait till the last minute!

An Ounce of Prevention is Worth a Pound of Cure

Most of us are familiar with the old adage that ‘an ounce of prevention is worth a pound of cure’, but how many of us have really taken it seriously?

The other day I was talking with a fellow physician about how successful the dental profession has been in getting this message across. When most of us were barely able to hold our own toothbrush, we were completely indoctrinated in how important prevention was to our dental health. I can still remember hearing about “Mr. Tooth Decay” and how evil he was!!!

How about you? Do you brush and floss your teeth daily? Do you manage to have your dental checkups on a regular basis? Certainly you understand the importance of prevention and do your best to maintain your dental health.

So how about the health of your spine?

Chiropractors have been encouraging their patients to take good care of their spinal health in much the same manner as dentists ever since the discovery of Chiropractic by Dr. Daniel David Palmer way back on September 18, 1895. Chiropractors know that maintaining the structural integrity of the spine is paramount to allowing the nervous system to properly regulate the myriad organs, tissues and cells of the body and therefore good health.

Most of us have observed how the elderly among us seem to ‘shrink’ as they get further along in their journey along the pathways of life. I can remember my Mom being 5’2” tall when I was a young man, and yet in the last years of her life she was a mere 4’8”! Mom had actually lost a full 6” of her height as the days, months and years of her life passed by.

What happened?

Just as our dental structures will deteriorate over the years without good preventative care, the human spine will also undergo deterioration with the march of time. Year after year the human spine is subjected to not only the various experiences of our lives, but the endless exposure to the force of gravity on a daily basis.

From the dental perspective we see cavities and rotting teeth, while in the spine we see deteriorating, bulging, protruding and herniating discs; and bone spurs that often end up putting undue pressure on vital nerve roots as the space between the vertebrae narrows.

The whole process of aging is truly fascinating.

Often patients are told that they have arthritis of the spine.  Other patients are told they have something called degenerative disc disease; or degenerative joint disease or osteoarthritis. Sounds like a disease huh? In actuality all of those fancy sounding names are really just another way of saying that your spine is aging.

So what can we do about it? Is there a way for us slow down or prevent the aging process?

This brings us back to the old adage of ‘an ounce of prevention is worth a pound of cure’.

The Radiologist’s Paradigm Shift

Recently I spent the better part of the morning with a radiologist from one of the local MRI imaging centers. We’ve known each other for quite a few years and while we were reviewing some lumbar MRI imaging studies on a patient, he asked me why we were not treating more patients with spinal decompression therapy in a ‘pre-emptive’ or preventative approach.  It was such an interesting question!

The radiologist shared that he had been reading spinal x-rays and MRI imaging studies for over 35 years and had always pondered how early in a person’s life he could begin to identify some sort of ‘marker’ that would indicate that the degenerative process had already begun. His feeling was that the earlier we could identify these changes and take ‘pre-emptive’ action, then the greater would be our chances of preventing or slowing down the degenerative processes of aging.

His point was that since nonsurgical spinal decompression was known to help heal injured discs and lessen the effects of spinal stenosis or narrowing, wouldn’t it make good sense to use that technique as a ‘pre-emptive’ form of preventative care for all patients who had evidence of degenerative processes on their imaging studies?

So how can we do this? I’m glad you asked!

Pre-Emptive Spinal Decompression Therapy

Patients who have demonstrated ‘degenerative markers’ on MRI imaging studies, with or without clinical signs and symptoms, may benefit from Pre-Emptive Spinal Decompression Therapy(PESDT).

PESDT is a form of rehabilitative therapy that utilizes therapeutic exercise, nonsurgical spinal decompression, and manual therapies to slow and/or reverse degenerative processes in the spine and associated connective tissues.

PESDT treatment protocols involve focused rehabilitative programs that require a minimum of 90 days and individual cases may require longer programs. Long term case management often includes periodic assessments with follow up MRI imaging studies for assessment.

Are You a Candidate for PESDT?

If you have had a previous MRI imaging study that has demonstrated degenerative conditions within your spine, or have been told that you have some form of degenerative spine disease you may very well be a candidate for PESDT.

Those patients who demonstrate a history of recent or chronic lower back pain, especially those with sciatica or any form of pain in the buttock or lower extremities, are in need of PESDT.

Want to learn more?

Please visit our website at: www.naturalpainsolutionsportland.com or www.npspdx.com

 

For a complimentary 30 minute consultation please call Carol at: 503-684-9698