Alternative Medicine and Alternative Coverage

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As a health insurance provider do you have clients who are part of the one-third of Americans currently using alternative medical options? According to some reports, people making alternative choices are paying out of pocket (in addition to any health insurance premiums or ACA fines) upwards of $34 billion dollars a year, out of the $1.5 trillion (or so) that the United States pays in total for health care, for care that includes increasingly mainstream products and procedures.

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First of all, what is some of the alternative medicine making the list (sometimes called CAM, complementary and alternative medicine)? These can include acupuncture, homeopathy, naturopathy, electromagnetic therapy, biofeedback, hypnosis, blood irradiation, physical therapy, light therapy, homebirth and midwifery, and a whole additional list of preventive care. Many alternative options are for procedures as well as pain treatment or management, which is no small market itself. In the era of America’s opioid crisis, many consumers are also looking at alternative ways to handle pain, whether that be post-surgery or birth, or to handle more of the chronic variety type of pain. No one starts out after a medical procedure thinking, “Hey, while I’m at it, I think I’ll start an opioid addiction that will completely ruin my life and all of the lives of those around me! Nurse, where’s the OxyContin?!”  

Clearly, like everything, traditional health care is not for everyone. But if everyone from fiscal conservatives to the ‘crunchies’ are consistently making alternative choices, why does traditional health insurance cover only traditional health care? The answer may lie in the question itself (tradition!), however the bottom line may be summed up in the following factors:

• Fear of the unknown - traditional medical procedures and medicines have a track record, for good or bad, there is generally a clinical record;
• Politics - health care has been the national hot potato that burns anyone it lands on since about 1992, and usually no one wants to end up with it in their lap for long;
• Big Pharma - let’s just put it this way, drugmakers have a lot of money and sway, more so than, say, ‘Big Herbs’, which does not exist;
• Keep costs down/eliminate waste - this might be self-explanatory, or not. If providers are trying to keep costs down across the board, disallowing certain procedures sounds like a way to cut costs, especially if the insured seeks CAM in place of covered providers.

With the ACA requirement to carry health insurance or face the ACA fine, be ready as health insurance providers for your customers to ask for more options. Or better yet, go proactive and use it to sell your plan. With consumer sites encouraging insureds to get their alternative choices covered, it’s likely you’ll end up talking to them anyway. One corporate plan manager, explaining a new health insurance plan to a company, called out the coverage for acupuncture and chiropractic manipulations for the medically necessary treatment of illness or injury. For an office where 28% of employees are patronizing a chiropractor, this is the true definition of a ‘benefit’.

So, the plan says that ‘therapeutic massage’ is not covered. But many clinics are reporting that through a variety of methods, whether that be medical referral or prescription, their clients are receiving reimbursements. What does that mean? Customers are negotiating with their health plans to find ways to get alternatives paid for. Consumers, in the years prior to the ACA, knew enough to know that their insurance plan did NOT dictate what procedures they could receive. If a consumer wanted acupuncture in the past, they just did it the old-fashioned way, they paid for it themselves. And it’s no secret that medical offices, even hospitals, are notorious for offering, for example, cash discounts or payment plans. Ask anyone who was an independent contractor in the pre-ACA fine period and purchased their health care a la carte.

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But, in the new era of ‘pay for health insurance or pay a fine’, the consumer who now HAS to pay for insurance, also wants that insurance to pay for the type of care for which he or she has been paying for years and does NOT want the double payment of insurance (or fine) AND their choice of healthcare.

As a provider with clients, are you an advocate for the one-third who are using ‘alternative care’? One of the top issues in insurance for 2017 is the automation of insurance jobs. Here’s your “live-human vs. robot” advantage: a software program is never going to sit down across from the client and talk about what they really want and need. Find out what services they are already using and advocating for and get onboard. If you can incentivize clients to have fewer claims through preventive choices, maybe the same would hold true if clients had their own choices in treating their ailments. A good business move that at least a third of your clients will appreciate is a good alternative for anyone in the insurance business.

Karla Allen is a researcher and writer for a variety of trades for At Your Pace Online, an online education provider, including einsurancetraining.com.