Alternative Therapy Finally Gets The Nod

Consumer demand is prompting insurance companies to change their ways

B.J. Shelby jokingly calls herself the self the “Bionic Woman.” Painful arthritis left the Houston resident so debilitated, she had her hip joints, knee joints, elbows and left shoulder surgically replaced in 1989. When the pain persisted, the 51-year-old turned to biofeedback, meditation, massage and nutritional counseling.

Karen Gutloff “I have finally turned the corner on this illness,” says Shelby, who was forced to retire as a bookkeeper because of her disability. “When I combined the alternative treatments with traditional medicine, it made a real difference.”

Shelby is one of thousands of Americans treating and preventing illness by turning to alternative therapists. A landmark 1993 study published in the New England Journal of Medicine found that one in three Americans sought help from alternative health providers. The study says consumers spent a whopping $13.7 billion on these treatments–mostly paid for out of pocket.

But consumers may not have to pay for alternative medicine much longer. Insurance companies are finally beginning to pick up the tab. “It’s gone from no coverage at all and total dismissal of alternative therapies to the development of alternative provider networks,” says Brenda Adderly, an alternative medicine expert in Santa Monica, California. “Insurance companies are being pushed by consumers, who’ve been interested in these treatments for years.”

Insurance coverage of unconventional medical treatments began in the early 1990s. Some plans offer full payment, while others ask patients to contribute a small co-payment.

Oxford Health Plans, based in Norwalk, Connecticut, stepped into the alternative medicine arena in 1997, pulling together a network of 2,500 alternative practitioners. Oxford ensures that the practitioners are licensed and credentialed. If an employer has purchased an alternative medicine rider, enrollees make a co-payment of about $20 for alternative treatments. If not, enrollees are eligible for 15%-25% off the practitioner’s set fee.
“A survey of our members found that 34% were already using unconventional therapies in addition to their regular medical visits,” says James Dillard, Oxford’s director of alternative medicine. “By creating a network of licensed practitioners, we’ll ensure the highest-quality care.”

In January, Blue Shield of California launched its own alternative medicine program, called Lifepath. Nearly all of the company’s members are eligible. They simply present their insurance card to any of the 1,000 alternative therapists and specialists in the network and receive an average discount of 25% on visits; physician referral is not required.

Another forerunner is Blue Cross of Washington and Alaska. Only a small percentage of consumers in the HMO and managed care plan need referrals from a primary care physician.

Some people say cost-saving is driving insurance companies to embrace unconventional medicine. “They believe it’s a way to minimize costs by keeping people healthy,” says Adderly. Not so, says Dillard. “Actually it may end up costing us more money to pay for these treatments, since most people combine them with traditional therapies.”

Whatever the case, find out how your insurance plan fits into the trend. You may not be covered for alternative therapy now, but it could happen. Consider these guidelines.

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