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Health Insurance Coverage for Alternative Medicine - North Carolina

The cost of alternative therapies used to be paid out-of-pocket, to the tune of millions per year in the U.S. Today that is changing. It’s not news anymore that many alternative medicine practices work. There is a body of over 20 years of research for proof. Our National Institutes of Health includes the National Center for Complementary and Alternative Medicine (see their FAQ on paying for alternative health care). The health insurance industry is responding to the demand for coverage of massage therapy, acupuncture and other once “alternative” therapies alongside their traditional checkups and doctor visits.

Health insurance and health care are top issues on people’s minds. In the last presidential campaign, pollsters asked people about their biggest concerns.

  • 4th - the war in Iraq
  • 3rd - national security
  • 2nd - stagnant economy
  • 1st - healthcare

[Source: New Hampshire Democratic primary exit polls – reported by National Public Radio – January 28, 2004]

It’s worth checking how your health coverage covers alternative therapies, as many plans don’t effectively inform existing customers of the available Alternative Health Care coverage. The types of plans most proactive in including alternative health care options are the Preferred Provider Organizations (PPO) and Point of Service (POS). HMO (Health Maintenance Organizations) and Indemnity Plans currently favor physical therapy and prescription medications.

When checking for health insurance coverage, cover these points:

  • Is this treatment covered for my health condition?
  • Does this care need to be:
  • Preauthorized or preapproved?
  • Ordered by a prescription?
  • Ordered through a referral from my primary care provider?
  • Do I have to see a practitioner in your network in order to be covered?
  • Do I have any 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?
  • What do I have to pay out-of-pocket?

Insurance companies change slowly. You may find that your first attempt at reimbursment is not successful. Don't give up! There are some things you can do:

  • Know your plan, including what it does, and does not, cover. Ask your insurance company if you have questions.
  • Check whether the CAM practitioner's office or your insurance company has made a coding error. To do this, compare the codes on the practitioner's bill with the codes on the document you received from the insurance company.
  • If you think your insurer may have made a mistake processing your claim, you can request a review.
  • Get good documents from the CAM practitioner. Make sure they spell out the information needed by the insurance company, including CPT codes when applicable.

Benefits commonly included today in North Carolina health insurance are chiropractic, massage therapy, naturopathy and acupuncture. Pure energy therapies are still on the cutting edge, and may not be covered under your health insurance. However, they can be included in some of the other health insurance coverage options we are about to discuss: Flex spending accounts and discount programs.

Remember when dealing with health coverage, expenses must be to alleviate or resolve a physical condition or illness. Health insurance does not cover expenses that are merely beneficial to general health, or primarily geared toward spiritual growth.

Flexible Spending Accounts (FSA) and North Carolina Health Insurance

Many employers in North Carolina offer Flexible Spending Accounts, either through the health plan or through the company. A Flexible Spending Account allows an employee to set aside a portion of his/her earnings to pay for qualified medical expenses – pre-tax, which results in a substantial savings. Your health plan may include a FSA option you can use for alternative health care coverage. Think of it as saving the same percentage as your tax bracket – 28 percent or more!

Be sure to check if your FSA has any specific rules about covered expenses. As a general guideline, according to IRS Publication 502, medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body. These include the costs of equipment, supplies, and diagnostic devices needed for these purposes. However, medical care expenses must be primarily to alleviate or prevent a physical or mental defect or illness. They do not include expenses that are merely beneficial to general health

Affinity Programs and North Carolina Health Insurance

Many insurance plans now include Affinity Programs, which offer a discount on services like alternative medicine. Blue Cross Blue Shield of NC, for example, calls its Affinity Program Alt Med Blue. It covers offer Alternative Care through a discount program, making it more affordable. One of a family of Blue ExtrasSM programs are available to members at no additional cost and complement your health insurance plan. With these programs you get information on health related topics and discounts on everything from vitamins and supplements, to massage therapy,yoga, somatic education and laser vision correction. Save money and take charge of your health.

Alternative Medicine and North Carolina Health Insurance

In general, there are three different instances where insurance companies can be billed for alternative therapies:

  • Private health insurance companies such as a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO).
  • Motor Vehicle accidents or other accidents such as slipping and falling.
  • Worker’s compensation (WC) (sometimes known as Labor & Industries, L&I) which involves injuries that happen while a person is at work .

Private health insurance – includes managed care plans (PPO-Preferred Provider Organizations, HMO-Health Maintenance Organizations) major medical, Medicare and Medicaid. Medicare and Medicaid do not cover many alternative therapies, but can cover chiropractic care. If anything about the coverage is not clear or you have questions, contact the insurance company before you decide about having treatment.

Motor vehicle accidents and Personal Injury allow payments for services that are medically necessary. Personal Injury Insurance is part of an insurance policy that covers bodily and property damage. Chiropractic, physical therapy, and massage therapy in all 50 states is recognized as being medically necessary as long as you can verify treatment and show improvement. Auto insurance policies, for the most part, will pay the fees, if all paperwork is in order. Be sure to get receipts and make sure the health care practitioner is keeping progress notes. Check with your policy as there may be time or session limits. Also be sure you have the proof of “medically necessary” your policy requires – often a prescription from your doctor.

Worker’s compensation or Labor and Industries - Injuries that happen at work must be sent through the worker’s compensation plan. This will include a motor vehicle accident that occurs while working. Often other insurance coverage such as a PPO will deny payment when an injury is due to a work situation. (i.e.- when a person who is injured at work tries to bill their PPO for the services, coverage can be denied) There are usually limits to treatments times, number of sessions and who can provide the treatments. You may have to apply to become a provider in each state and abide by the provider contracts. The goal is usually to get the worker back to work as soon as possible. There are limits to the policies

You CAN Make a difference - And get covered for some alternative therapies

It would be easy to blame people in power for the problems in healthcare, but, in the short term, it is unproductive. We must use our dollars and our votes to make a better America. As we change our own approach to healthcare, the national system has to adapt to suit us, and it will change in a positive way.

Gandhi said, “Be the change you want to see in the world.” By choosing your own approach to healthcare, you cannot help but change things at a national level.

A wonderful reference for taking charge of your health care is available as a free downloadable e-book:
Health Off the Grid by Daryl Kulak. "A Nine-Step Guide to Helping Your Health Insurance Serve You Affordably and Holistically”

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