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Insurance and Complementary / Alternative Medicine

12 Most Common Questions

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Updated September 22, 2011

If you don't have insurance coverage for treatment and paying the full fee each time would be difficult for you, you might ask:
  • Can your office arrange a payment plan so that my costs are spread out over a longer period of time?
  • Do you offer a sliding-scale fee? A sliding scale fee adjusts charges based on a patient's income and ability to pay.


5. What about complementary and alternative medicine insurance coverage that may be offered through employers?

If complementary and alternative medicine coverage is offered, it is usually one of the following types:
  • Higher deductibles. A deductible is a total dollar amount that the consumer must pay before the insurer begins making payments for treatments. Under this type of policy, complementary and alternative medicine coverage is offered, but the consumer pays a higher deductible.

  • Policy riders. A rider is an amendment to an insurance policy that may change coverage in some way (such as increasing or decreasing benefits). You may be able to purchase a rider that adds or expands coverage in the area of complementary and alternative medicine.

  • A contracted network of providers. Some insurers work with a group of complementary and alternative medicine providers who agree to offer services to group members at a rate lower than that offered to non members. You pay out-of-pocket for treatment, but at a discounted rate.
Employers negotiate with insurance companies for plan rates and services. This is done on a periodic basis (usually annually). You may wish to let your company's benefits administrator know about any coverage preferences you have. If your company offers more than one plan, evaluate carefully what each one offers, so you can pick the plan that best meets your needs.

The Agency for Healthcare Research and Quality (AHRQ), a Federal agency, has helpful publications about choosing and using a health insurance plan.

6. My insurer has asked me for evidence, from scientific and medical literature, about the use of a complementary / alternative medicine treatment. Where do I find it?

The National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse can help you find information from the scientific and medical literature on alternative medicine. They use databases of peer-reviewed scientific and medical journals, such as CAM on PubMed.

7. My insurance company has denied my claim for a complementary / alternative treatment. Is there anything I can do?

There is nothing more frustrating than finding out a claim is denied. It has even happened to people after they have verified over the phone with an insurance company about a particular treatment.

As discussed earlier, make sure you know your policy including what it is, and is not, supposed to cover. Check whether there has been an error in the coding or billing of your service (called a coding error), either by the practitioner's office or by the insurance company; 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 made a mistake processing your claim, you can request a review from the company.

Also, the insurance company should have an appeal procedure and provide a copy of it with your policy. It may be helpful to discuss with your practitioner whether she can do anything on your behalf, such as writing a letter. If you have taken these steps and the problem is not resolved, contact your state insurance commissioner's office, which has consumer complaint procedures.

8. Are there laws to help me keep my health insurance if I lose or change jobs? Do these laws apply to complementary and alternative medicine treatments?

If you currently have an insurance plan that includes any complementary and alternative medicine coverage, the following laws may be of interest to you.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 offers limited protection for many employed Americans. HIPAA protects health insurance coverage for workers and their families if the worker changes or loses his job. The law:
  • Limits the ability of insurance companies to refuse coverage based on preexisting conditions.
  • Prevents group health plans from denying or charging more for coverage because of past or present poor health.
  • Assures renewal of coverage, regardless of any health conditions of people covered under the policy.
  • Guarantees certain small-business employers, and certain people who lose job-related coverage, the right to buy health insurance.
The Centers for Medicare and Medicaid Services can provide you with the general information on the Federal HIPAA program. Note that individual states may have specific laws related to HIPAA requirements; if you need more information on HIPAA in your state, contact your state insurance commissioner's office.

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