by Cara Gardner
We find most of [our clients] confused about what their insurance will cover," says Norrine O'Mara, a licensed acupuncturist at Synergy in Spokane. "We try to contact the insurance companies and determine what it will cover, or explain it, but it's hard to explain."
Co-payments, number of sessions, reasons for treatments -- that insurance companies in Washington state are required to cover some alternative and complementary providers is one hurdle, but how to navigate the policies, and whether that coverage will apply to you, is a whole different set of challenges.
"Some people know, some don't; some have tried everything, are in pain and just don't care," O'Mara says, regarding how her patients respond to the insurance system. Some people simply pay out of pocket for alternative treatments because they don't want the hassle of dealing with their insurance company. But according to the National Center for Complementary and Alternative Medicine, there are some basic points every healthcare consumer should follow when they're seeking coverage for alternative care.
4 Talk to your primary care provider before anything else. Your doctor may be aware of which, if any, complementary or alternative treatments will benefit you. Find out what he/she thinks about the treatments you're considering, and find out if you need a referral or prescription from your doctor to have those treatments covered by your insurance.
4 Contact your insurance company. Most of them have comprehensive Web sites, with lists of providers and treatments that are covered under different plans. Make sure the alternative or complementary practitioner you plan to see is certified under your insurance plan. Read the policy to find out what the co-pay is, how many treatments are covered and what the loopholes are regarding coverage. For instance, some insurance plans will cover a check-up with a naturopathic physician only if you haven't already used your allotted check-ups with your primary care physician.
4 Research both the complementary or alternative healthcare treatment you are considering and the practitioner you are going to visit. Find out what the pros and cons are regarding your treatment, and the possible side effects. In Washington, make sure the practitioner is licensed by the state. In Idaho, check to see if the practitioner has graduated from an accredited school of complementary or alternative medicine, and see if he/she is licensed in any other state. If not, talk to the practitioner about why, and ask to talk to his/her other patients and colleagues.
4 Think critically about the information you are getting when you read information on the Web. Find out what agency, institution, organization or government body runs the Web site, and look for signs that the information is backed by peer review and valid sources. Don't assume what you read is completely true just because a doctor has written it; make sure that what the doctor has written has been validated by other experts in his/her field.
4 Be clear with your complementary or alternative practitioner about what your expectations are regarding treatment. Also, have realistic goals; alternative medicine focuses more on health, prevention and management of pain or illness. Be wary of promises for "miracle cures." -- Cara Gardner
For more detailed information about complementary and alternative medicine, visit the National Center for Complementary and Alternative Medicine, NCCAM, Web site at: www.nccam.nih.gov.
Publication date: 07/22/04