In the past few years, health insurers across the country have begun increasing their coverage to include therapies such as acupuncture. These increases, made at both the state and national levels, highlight the growing acceptance of alternative therapies by insurance companies and the American public, and are expected to have a significant impact in the way millions of people view and use complementary and alternative medicine.*
Some of the greatest activity concerning coverage for alternative forms of care has taken place in Arizona, California, Michigan, Nebraska and South Carolina. *Among the more recent developments most important to Californians:
Members of the Blue Cross/Blue Shield Service Benefit Plan now have access to a national network of acupuncturists, massage therapists and chiropractors, and can also receive discounts on health and wellness products. This expanded access to alternative care providers is the result of new program instituted by Blue Cross/Blue Shield and administered by American Specialty Health Networks (ASHN), a San Diego-based provider of practitioner networks and managed care programs.*
Under the agreement, Service Benefit Plan members will receive discounts of up to 25% on office visits to ASHN acupuncturists. Members will not have to get a referral from their primary care provider to take advantage of these benefits; instead, they can contact a network acupuncturist, directly to make an appointment.*
In 2001, when this change in health coverage was at its peak a representative stated in a article for Acupuncture Today publication, :"We recognize our members' desire for more choices and direct access to CAM services. Thus, we are excited to offer to our members for the very first time access to a discounted CAM affinity program," said Steve Gammarino, senior vice president of the Federal Employees Health Benefits Program (FEHBP). The Blue Cross and Blue Shield Service Benefit Plan is the largest health insurer in the FEBHP, covering approximately four million federal employees, retirees and family members.*
In present day, ASHN acupuncturist include: Aetna, Anthem Blue Cross, Cigna, Empire Blue Cross, Health Net, and Kaiser. In addition there are other insurance companies that have become in Network providers for Acupuncture: Health Smart, Optum Care, who handles alternative care for United Healthcare, Formerly Pacific care, and premera Blue Cross.
Kaiser and Sutter Health are both developing their own in house Acupuncture Pain Management departments. Which although don’t make use of all of what Chinese medicine has to offer in the way of treatment options for a variety of ailments and with a diversity of modalities. Both Medical organizations are taking advantage of the pain management effect of basic acupuncture treatment. Sutter Health has gone a little farther and included it as part of their fertility treatments regiments. Kaiser members are required to get a referral from their primary medical provider before they can take full advantage of the service using their plan. It may also be difficult to get a referral to see a practitioner outside of Kaiser although the practitioner is part of the ASHN network and is considered in Network of Kaiser.
Reasons for Coverage are Varied
The biggest question to be asked, of course, is why. Why are more insurers providing coverage for treatments that were considered controversial - and in some cases, unproven - just a few short years ago? The reasons for including alternative forms of care as part of a health benefit plan are almost as numerous as the therapies these plans now cover.*
Legitimacy. Acupuncture and herbal medicine are no longer considered "fringe" elements of health care. Scientific studies have shown that acupuncture is effective for a variety of ailments, from treating osteoarthritis and nausea to pain relief and addiction. Research into herbal products and supplements, meanwhile, has made dramatic strides in the past few years.*
"As there is a greater familiarity with these procedures and supportive scientific data, they are becoming increasingly more popular with patients," said Richard Coorsh, a spokesman for the Health Insurance Association of America. "They're also becoming increasingly more reimbursable by insurance companies."*
Increased Use. Another reason insurers have begun covering alternative therapies is because more patients are using them. In 1990, an estimated 60 million American adults tried some form of "unconventional medicine." By 1997, that figure had increased to 83 million, and the number is expected to grow even more in the next decade.*
In 2001, in an article for Acupuncture Today it is states: "The members were asking for it," said Laurie Kelly, a Health Alliance Plan spokeswoman. "They want it as a full benefit. By offering it as a discount, we're able to test the waters and establish a network of providers. We're trying to empower our members."*
Market share. Perhaps the most important reason insurance companies are covering acupuncture and herbal medicine has to do with competition. Alternative care coverage has become a main selling point for health insurers. The insurers want to keep their current customers happy while making themselves more amenable to prospective customers. The best way to do that is by listening to their customers' needs and then finding a cost-effective solution that benefits both parties.*
"It's a value-added (benefit) for our members," commented Helen Stojik-Nelson, a spokeswoman for Blue Cross/Blue Shield of Michigan, when asked about the advantages of the Naturally Blue program. "It helps them try out services or have the ability to have more services than they ever had before."*
"Health plans are doing this in response to the wishes of their members who want access to these services," added Gerald Griffith, chair of the health care department at Honigman, Miller Schwartz and Cohn, a law firm in Detroit. "They are reacting to the market they serve, which makes good business sense.*
"In this competitive environment, these programs add value to a health plan. This type of program may not cause someone to stay with a particular plan. But this, along with the other health care benefits, can make a plan a lot more attractive."*
Decreased Availability. The reason for decreased availability depends on the company who has contracted with the insurance company. Many companies offer limited coverage in their plans to reduce cost. Not realizing that offering alternative health options would contribute to over wellness and decrease on major medical use and lost in labor production hours, thereby greatly reducing their cost.
Deficiency Of Plans. Most plans don’t cover herbal medical therapy. Most plans don’t cover physical therapies, like tuina, reflexology, moxa, cupping, nutritional counseling and gua sha, which are other modalities used by Acupuncturist to treat their patients and are in the scope of their practice.
Where Will We Be In The Future Of Health Care. President Obama has started to reorganize health care, which is great for the American people but it lacks all the advances that have developed in the last few years. There was an initiative for the Essential benefits of health care to include acupuncture but as of yet Acupuncture has not been included in the essential benefits of health care. It will take the American public outcry to change that flaw in the new health care system, in efforts to regain the advances it took so long to accomplish.
Jame’e Brazie’r L.A.c. MSTOM Licensed Acupuncturist and in Network provider for several Health Insurance carriers for Three Lotus Dragon Acupuncture Wellness Center, 328 N. San Mateo Dr. Suite C. San Mateo, CA. 94401
*Acupuncture Today issue 09 September 2001 Vol. 2 by Michael Devitt , More Health Plans Offering Coverage for Acupuncture and Herbal Medicine