Although there has been some movement within California health insurance plans to cover alternative treatments, it's been a slow process and still has more work. Alternative health care typically looks at a more holistic and preventative approach to treating health ailments. Two of the most common forms of this treatment which have made it into the benefits summaries (that's a big deal) are chiropractic care and acupuncture. These are clearly not the only examples of alternative care and we've a definite increase in California health insurance shoppers asking about particular treatments and how they are handled by health plans. Let's try to shed some light on alternative care and health insurance.
Now most of the people we speak with on alternative care will continue with this treatment regardless of how some health insurance carriers views it but it would be nice to get coverage especially since an argument can be made that it prevents future health care expense (of the very expensive kind). To some extent, Western health care delivery's focus on treating symptoms has become too expensive for our society to really manage and more thought to preventing health conditions in the first place needs to be embraced. This is where alternative health treatments can complement our existing health care delivery system.
Alternative health insurance generally involves Acupuncture, Massage Therapy, Chiropractic, Yoga, and Hypnotherapy as well as other practices. In terms of coverage by California health insurance plans, there are two concerns. First, we need to make sure the provider is a licensed practitioner. In general, a health insurance plan will not cover services by someone who is not a licensed medical provider. The next big concern is whether they are in-network providers which can significantly affect your out of pocket expense. We also need to make sure that the actual service is covered. Most homeopathic or alternative providers have a good sense of how specific services will be viewed by health plans since they deal with them all the time. That's a good time to ask them and/or your carrier for more guidance.
Chiropractic and Acupuncture benefits are usually broken out separately in the benefit detail due to their popularity. Depending on the plan you have and the market segment (individual versus small group), the benefits might not be terribly rich for these services. The carriers will usually pay a fixed amount towards services but only after deductibles are met and since most people choose high deductibles these days, these benefits are rarely enjoyed. If you use in-network providers, you might be able to get the negotiated PPO rate.
Health Reform is not significantly affecting the treatment of alternative care going forward. If anything, people will be required to pay more or "subsidize" traditional medicine through the mandates for coverage. One silver lining is that the plans are richer and therefore, lower deductible will be met in order to get alternative health care covered but those plans will be so expensive, we'll likely all be on the least rich couple of plans available unless we qualify for subsidies (make under 400% of poverty).
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