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The health care you want, the coverage you need: with a little coaxing, your insurer just might pick up the tab for alternative therapies

Vegetarian Times, March, 1997 by Karin Horgan Sullivan

TAKE IT FROM ME, welling up with tears is not what you want to do the first time you meet one of your company's big cheeses. The occasion was a staff meeting about our switch to a different health insurance provider, and the new vice-president of human resources had just informed me that homebirth would no longer be covered.

I wasn't pregnant nor was I planning to be anytime soon. But I looked forward to having a family someday, and I intended to give birth in the peace and comfort of my home. I was unexpectedly overwhelmed by the idea of going through labor in a place I didn't want to be; I felt like one of my rights had been snatched away from me.

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I shouldn't have felt so entitled because coverage of alternative health-care choices is rare in this country. In 1995, Business and Health, a magazine for the managed-care industry, surveyed 653 executives at U.S. companies of varying size. They found that just 12 percent of the executives' companies provided insurance coverage for alternative therapies such as acupuncture, massage or chiropractic.

However, this same survey also found significant evidence of a shift toward increased coverage; 18 percent of respondents predicted that their companies' plans would cover alternative therapies by 1997. "That's a great deal of movement toward coverage actually," says John Weeks, director of Integration Strategies for Natural Healthcare, a Seattle-based business that advises companies on how to incorporate coverage of alternative care. "My best guess is that 18 percent is a conservative estimate. But that's as solid a piece of data as I've seen at that level."

Another positive sign is that even health maintenance organizations are starting to enter the alternative arena. Last fall, Oxford Health Plans Inc. of Norwalk, Conn., an HMO that serves 1.4 million people in the Northeast, announced the creation of a network of chiropractic, acupuncture and naturopathic providers. Members of this HMO can go directly to these new specialists without prior approval from their primary-care physician. The care they receive is covered in full. In addition, patients can purchase yoga lessons, massage and nutrition services, herbs, vitamins and other supplements at a discount. If a highly profitable, well-respected HMO such as Oxford is taking alternative coverage this far, says Weeks, "everyone better sit up and take notice."

Weeks reminds consumers that, from the insurance industry's point of view, there are good reasons why coverage has not been immediately forthcoming. "The industry is in such turmoil over the shift to managed care that virtually all plans are scrambling to get on top of their conventional business," he points out. "It's hard to cut loose the time and resources to look at a whole new market and to respond." Furthermore, there is agreement on all sides about the lack of data on the cost benefits of covering alternative therapies. "We really need a five-year study to find out if covering alternative therapies is cost-effective," says Steve Gorman, president of Alternative Health Insurance Services in Thousand Oaks, Calif., the first insurer to cover alternative therapies for individuals, not just employer groups. "There's greater utilization of services at first, so costs can be higher in the early years of coverage." While consumers may binge on alternative therapies when they're first made available, Gorman has no doubt that over the long haul, coverage will save companies money, but "there's just not enough credible documentation now."

Even without this hard data, the consensus is that consumer demand is driving insurers to increase coverage of alternative therapies. And sources repeatedly say that the more vocal consumers are, the faster they are likely to win coverage. How can you speed this process along?

GO PUBLIC WITH YOUR

HEALTH-CARE CHOICES

IT MAY SEEM obvious, but the first step in getting coverage is to tell your insurer which alternative therapies you're using and what you want reimbursed. "A lot of insurers say, `Well, we just haven't heard there's a demand for coverage,'" says Weeks. "What I would say to the consumer is, get out of the closet with your alternative-care choices and make sure you're sharing them with insurance providers and the benefits people at your company."

Send in claims for any alternative services you use, even if they aren't likely to be covered. Patricia Blanch, program manager of special markets and dental products at BlueCross BlueShield of Massachusetts, says her company decided to develop an alternative-therapies plan based on the volume of claims it received for non-reimbursed services, such as acupuncture and homeopathy. In other words, all those "denied" claims were counted as votes for alternative coverage.

If your claim is denied, follow up with a letter to the insurance company's marketing manager or product-development manager, requesting that the company consider covering the services you use. Include personal anecdotes about how the therapy benefited not just your body but your pocketbook, recommends Kirk Molten, an acupuncturist and co-founder of American Holistic Centers, based in Chicago, a group of medical practices where alternative practitioners work part-time as independent contractors under the supervision of full-time physicians. In 1995, for example, 15 patients visited the center because their physicians had recommended they undergo a laminectomy, a back operation that costs around $30,000. After undergoing a variety of alternative therapies at the center, at an average cost of about $3,000, only two patients ended up still needing the surgery. "If someone calls up the head of benefits and says, `Look, I just saved you guys $30,000 [in surgery costs],' that's what's going to make people sit up and take notice," says Molten.

The health care you want, the coverage you need: with a little coaxing, your insurer just might pick up the tab for alternative therapies

Vegetarian Times, March, 1997 by Karin Horgan Sullivan

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