COVERAGE FOR ALTERNATIVE MEDICINE

During the 1990s, the use of alternative medicine increased dramatically, with estimates that over half of the population has used one or more of these types of services. In addition, the majority of physicians have recommended alternative medical techniques, particularly for treatment of neck and back problems, anxiety, depression, and headaches. Examples of alternative medicine services include the following:

Acupuncture

Biofeedback

Chiropractic treatment

Herbal medicine

Homeopathy

Hypnosis

Massage therapy

Meditation

Relaxation

Therapeutic touch

Vitamin therapy

Yoga

The attractiveness of these programs has increased over the past few years for a number of reasons. Patients appreciate the rapport they develop with their alternative medicine practitioners, and this is indicated by a higher degree of satisfaction with these practitioners than with their physicians. Patients also like the fact that alternative medicine practitioners are more likely than traditional medical practitioners to actively involve patients in the development of treatment plans. As a result, patients are more likely to follow plans of alternative medicine than they are to follow conventional medical treatment plans. Finally, complications from treatment are less likely than from conventional medical treatment, possibly because of the less-invasive nature of alternative medicine.

Insurers and plan administrators have typically been leery of adding benefits for alternative medicine because they fear increases in claims costs. This will obviously occur if alternative medicine is used in addition to traditional medical treatment. However, it is often used as a replacement for traditional medical treatment. If successful, costs might decrease. There is also concern over the qualifications and training of many of the persons who provide alternative medicine.

Many insurance contracts and managed care plans provide limited benefits for chiropractic treatment, and a smaller number cover acupuncture, sometimes as a result of state mandates. However, benefits are often subject to limitations. Some providers of medical benefits will add other types of alternative medicine to their insurance contracts or managed care plans if the employer is willing to pay an increased premium. Employers may be willing to pay this cost as a response to employee interest or to differentiate their medical expense plan from those of other employers. Results of surveys vary, but it appears that over half of employers have benefit plans that cover chiropractic services, about 20 percent have plans that cover acupuncture, and about 10 percent have plans that cover some other forms of alternative medicine.

To control costs, coverage of alternative medicine is subject to a variety of controls. These include one or more of the following:

Annual or lifetime dollar limits

Limits on the number of annual visits

A requirement that treatment is for specified medical conditions

A requirement for a referral from a primary care physician