Does Your Health Insurance Cover Alternative Medicine?

About a third of U.S. adults use some form of alternative medicine, and most of them likely pay for it out of their own pocket. Alternative methods – from supplements to acupuncture – are used in preventive care as well as the treatment of chronic and acute conditions, but they often aren’t covered by health insurance.

There isn’t one reason why people choose alternative approaches over traditional medicine. One study published in Social Science & Medicine found that patients who choose a homeopath over a general practitioner are likely to do so because of “disenchantment with, and bad experiences of, traditional medical practitioners.” Another in the Journal of the Medical Association suggested that people were motivated more by personal values, beliefs and philosophical attitudes about health.

Regardless of these findings, one thing is clear: Americans aren’t flocking to alternative medicine to save money.

The Cost of Alternative Medicine

Americans spent more than $33.9 billion out of pocket on alternative and complementary medicine in 2007, the latest year for which comprehensive federal data are available. That amount includes visits to providers such as chiropractors and massage therapists, as well as products like supplements. While alternative medicine accounts for only about 1.5 percent of total health care spending in the U.S., it comprises 11.2 percent of total out-of-pocket health care spending, according to the 2007 National Health Interview Survey.

There's a perception is that alternative medicine is growing in popularity, with numerous websites dedicated to “natural health” and home remedies. But the research disputes this. According to an analysis of the Medical Expenditure Panel Survey from 2002 to 2008, the use of alternative medicine and spending on these services plateaued – something blamed in part on the higher proportion of out-of-pocket costs.

Alternative Medicine and Insurance Coverage

When considering reimbursement, the Affordable Care Act mandates that insurers not discriminate against licensed health care providers, including those who practice alternative medicine, such as naturopaths, massage therapists and acupuncturists. But that isn’t the same as requiring coverage.

Health insurers can limit coverage they deem experimental or not medically necessary, and they often do. Aetna, for example, says it considers alternative interventions medically necessary only “if they are supported by adequate evidence of safety and effectiveness in the peer-reviewed published medical literature.”

So while such things as acupuncture, biofeedback, chiropractic care and electronic stimulation may be covered under their policies, music therapy, aromatherapy, therapeutic touch massage and a long list of other interventions are not.

Even when services are covered by an insurance plan, the insurer may require a statement of medical necessity or prescription from a primary care doctor. The coverage may also provided limited visits or cover only some of the services the provider offers.

Knowing Your Coverage Details

Health insurance coverage for alternative medicine is a mixed bag, varying from policy to policy. Your best bet is to make some phone calls and ask the right questions before making an appointment with a practitioner.

1. Call your insurance company. Ask your insurer the following questions:

• Am I covered for this treatment?

• Do I need a referral or prescription from my general practitioner?

• Will I have to meet a deductible or pay a copay?

• Am I limited to a certain number of visits?

• What are some local providers in my policy network?

Make sure you write down who you talk to and what they say, should any coverage issues arise down the line.
2. Contact local providers. Next, call treatment providers, making sure to discuss the insurance plans they accept and their rates. Some alternative therapies, like chiropractic care, tend to cost more for initial visits than they do for follow-up appointments. Get a good estimate of how many visits you’ll need to reach recovery or a point where returning won’t be necessary.

3. Find out about additional costs. Ask your insurance representative and providers whether there are any additional costs you should know about. If, for example, your provider recommends that you add supplements or if your insurance company covers one treatment but not another, unexpected limitations and add-ons could come with a hefty price tag.

4. No coverage? Negotiate. If your health insurance doesn’t cover the services you want, see if the treatment provider is wiling to negotiate. Practitioners may be willing to put you on a payment plan or offer discounts to cash-paying customers.

Like most Americans who opt for alternative health care, you’ll be paying out of pocket for at least some of your costs. Knowing just how much you’ll be charged can help you budget for them ahead of time.