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“Alternative medicine therapies and their potential inclusion in your healthcare plan”

by EINSURANCE

“Alternative medicine therapies and their potential inclusion in your healthcare plan”

 

Complementary and alternative medicines, also called CAM medicine, are two healthcare systems that have been utilized by increasing numbers of American patients and medical practitioners within the past several decades.  The most recent National Health Survey (2007), sponsored by the federal government and which provides an in-depth examination of American citizen healthcare experiences, found that approximately 38% of adults currently use some form of CAM procedures or products [1, 2].  Mirroring this percentage is the $36 billion dollars of out-of-pocket and tax-generated funds that are used every year to use, prescribe, and research CAM medical practices and products [1].  The movement for CAM medicine has been so popular in fact that even a portion of income tax revenue (~$130 million) used to generate the U.S. National Institutes of Health’s annual budget is allocated to the National Center for Complementary and Alternative Medicine (NCCAM) [3].  This center’s directive is to fund scientific research and clinical trials across many disciplines that explore, validate, and expand CAM medical procedures within the United States [3].  Seeing the growing trend of CAM popularity and potential value to the current U.S. Healthcare System, we at EInsurance.com wanted to provide you with some information regarding these procedures and provide insight into how health insurance providers are viewing this growing trend. 

 

CAM healthcare includes, as mentioned, both alternative medicine and complementary medicine.  Alternative and complementary medicine, according to NCAM [4], the National Science Foundation (NSF) [5] and the National Institute of Medicine (IOM) [6], are a set of combined practices, systems, and products devoted to promoting wellness and illness remedy via non-Westernized medical or allopathic practices.  In the United States, allopathic practices are performed only by state-certified health professionals that hold M.D. or D.O. degrees and other allied health professionals, such as registered nurses, physical therapists, and psychologists [2].  In contrast, alternative and complementary medical procedures can be practiced by individuals that do not have a specific education or license [7].  In response to the demand for CAM healthcare, states have begun to institute education, licensing, and registration programs for CAM providers in hopes of regulating these practices [7].  Additionally, professional organizations offer credential programs for members seeking to practice CAM methodologies [7].  However, because of the lack of federal regulatory bodies for CAM, regulations and guidelines for care vary widely as well as enforcement of malpractice and misuse by providers.

 

In order to insure a successful dialogue with your health provider and benefit carrier, it is important to understand what kinds of procedures are classified as “alternative” in regards to widely-accepted allopathic practices, why you might need them, and what to look for in insurance policies/programs so that you might offset the cost of care.  Generally, alternative medicine can be split into five groups [2].  They are as follows:

  1. Biological-based practices: natural product or non-synthetic compound usage
  2. Manipulative or body-based practices: body part manipulation or movement to ease pain or illness
  3. Energy medicine: using energy fields (quantifiable or putative) to penetrate the body
  4. Mind-body Medicine: holistic approach to using the mind to control body reactions and function
  5. Cultural medicine: practices used in non-western cultures to bring health and improvement to the body (i.e. Chinese medicine, Naturopathy, Homeopathy)

 

 

Within these five groups, the classification boundaries are often unclear, and usage of multiple groups can be used to help treat one or many illnesses and symptoms, as well as for preventative care.  Some more common procedures or products are listed below:

 

  • Natural vitamins, minerals, or botanicals
  • Dietary supplements
  • Probiotics (bacteria)
  • Meditation
  • Yoga
  • Acupuncture
  • Hypnotherapy
  • Tai chi
  • Massage therapy
  • Spinal manipulation or chiropractic services
  • Pilates
  • Osteopathy
  • Magnet therapy
  • Reiki
  • Aroma therapy
  • Biofeedback

 

Though CAM medicine has had historical, cultural, and widespread use, scientific and rigorous validation of their health benefit is still lacking and has been so for approximately a decade or more [8].  Because of this lack of scientific evidence and support, insurance companies choose to exclude complementary and alternative medical practices in current healthcare policies.  In their business models, if scientific testing and analysis do not support a health benefit of particular procedures or products, and credentialed professionals do not endorse these practices, these procedures must not constitute a profitable and worthwhile market in which to conduct business.  Luckily with research being conducted by institutes like NCCAM and published by scientific organizations such as the Journal of Alternative and Complementary Medicine & Biomedical Central Complementary and Alternative Medicine, CAM methodologies, practices, and products have the potential to move into allopathic medicine.  This lateral movement has become essential to inclusion of these practices into healthcare/insurance policies though these procedures may still involve paying higher deductibles than other therapies.  Examples of such procedures recently included in many group health insurance plans are cognitive-behavior therapy, mediation, chiropractic care, massage, nutrition counseling, and yoga.   Additionally, some insurance companies may provide contracted or discounted procedures that fall under complementary and alternative medical practices, but like many companies this is usually on a per policy or per group plan basis. 

 

A few key ways to get coverage for alternative or complementary procedures is to engage your medical provider, your insurance carrier, and also to understand the safety and efficacy of treatment.   In order to achieve these objectives, research into the procedure or practice on your part, the consumer, is definitely the first step in knowing your alternatives.  Your doctor or allied health professional may also be able to help gather information about particular practices, and with this ally you can more appropriately present to your benefit carrier the importance of alternatives therapies for further consideration.   As your doctor or health professional are deemed the authority in determining medically-necessary procedures, getting them to agree to help you is a important move [9].   To help strengthen your claims to a particular alternative medicine approach, you can research them and information regarding health insurance plans at the following websites [2, 9, 10]:

  • The Federal Drug Administration Program  (www.fda.gov) - regulation of dietary supplements, safety tips of particular drugs, and over-the-counter remedies
  • Pubmed (www.ncbi.nlm.gov/research/sites/entrez) - publically accessible scientific articles and reports maintained by the National Library of Medicine
  • Medline Plus (www.medlineplus.gov) - authoritative information from the National Institutes of Health and other government agencies
  • Federal Trade Commission (www.ftc.gov) - information on enforcement actions for advertising purposefully misleading the public
  • Federal Trade Commission Health Consumer Information (www.ftc.gov/bcp/menus/consumer/health.shtm) - information regarding health-related enforcement actions for misleading or incorrect advertising
  • National Center for Complementary and Alternative Medicine Clearinghouse (www.nccam.nih.gov) - provides databases of scientific and medical literature including publications
  • Office of Dietary Supplements (www.ods.od.nih.gov) - office within the National Institutes of Health that evaluates reports and literatures and shares results with the public on findings and decisions about supplemental use in healthcare
  • U.S. Department of Labor  (www.dol.gov/topic/health-plans/index.htm) - general information on employer health plans and benefits
  • State Insurance Department (www.consumeraction.gov/insurance.shtml) - provides state information regarding who might cover CAM procedures
  • Federal Health Benefit Programs (www1.va.gov/health , www.cms.hhs.gov , www.govbenefits.gov , www.usa.gov ) – Explanations of veteran and federal health insurance policies and programs along with eligibility guidelines and tips

 

Overall, more and more CAM products and procedures are being tested for safety, efficacy, and in turn being included into preventative and reactionary healthcare needs.  Knowing the in and outs of the procedures and products you are interested in will not only help you understand its potential benefits but will in the end make you a more informed consumer of healthcare in general.  We wish you luck!

 

This article was written by:

Gregory Darnell, M.S./Ph.D.

Research Analyst &

Healthcare Communications Specialist

Department of Research

EInsurance.com

www.einsurance.com

 

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References

 

1.         Statistics, C.N.C.f.H.S.D.o.H.I., National Health Interview Survey : Supplement on Complementary and Alternative Medicine, 2007, National Center for Health  Statistics, Centers for Disease Control and Prevention: Hyattsville, Maryland. p. 5.

2.         (NCCAM), N.C.f.C.a.A.M., What Is Complementary and Alternative Medicine?, 2010, National Institutes of Health, Department of Health and Human Services: Bethesda, Maryland.

3.         (NCCAM), N.C.f.C.a.A.M. NCCAM Facts-at-a-Glance and Mission. [webpage] 2011 March 24, 2011 [cited 2011 April 5, 2011]; Available from: http://nccam.nih.gov/about/ataglance/.

4.         (NCCAM), N.C.f.C.a.A.M. Health Information. 2011 March 24, 2011 [cited 2011 April 5, 2011]; Available from: http://nccam.nih.gov/health/.

5.         Board, N.S., Science and Engineering Indicators, 2002, National Science Foundation Arlington, VA.

6.         Public, C.o.t.U.o.C.a.A.M.b.t.A., Complementary and Alternative Medicine in the United States, ed. B.o.H.P.a.D.P. (HPDP) and I.o.M. (IOM)2005, Washington, D.C.: The National Academies Press. 360.

7.         (NCCAM), N.C.f.C.a.A.M., Credentialing CAM Providers: Understanding CAM Education, Training, Regulation, and Licensing, D.o.H.a.H.S. National Institutes of Health, Editor 2010: Bethesda, Maryland.

8.         Atwood, K.C., The Ongoing Problem with the National Center for Complementary and Alternative Medicine. Skeptical Inquirer, 2003. 27.5.

9.         (NCCAM), N.C.f.C.a.A.M. Tips for Talking With Your Health Care Providers About CAM. [webpage] 2008 October 2008; Available from: http://nccam.nih.gov/health/decisions/talkingaboutcam.htm.

10.       (NCCAM), N.C.o.C.a.A.M. Paying for CAM Treatment. [webpage] 2010 April 5, 2011]; Available from: http://nccam.nih.gov/health/financial/.

 

 

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