According to 2008 information from the Centers for Disease Control and Prevention, 40 million Americans lack health insurance, and of those who are covered, many are underinsured with policies that do not adequately cover the cost of treatments and prescription medicines. If you are fortunate enough to work for an employer who provides insurance from a major carrier such as Aetna, Kaiser Permanente or Blue Cross, you may be covered for alternative as well as traditional care. But, before you go running to an acupuncturist for treatment of your back pain, do some homework first.
Rules Vary
Generally speaking, a Preferred Provider Organization, or PPO, is more likely to cover acupuncture treatments than a Health Maintenance Organization, or HMO, but rules vary considerably among companies and plans within the same company. Some plans offer discounted treatment for acupuncture and some pay for all or most of the cost, but only for certain conditions and for limited periods of time. You might visit an acupuncturist who recommends twice-weekly treatments over the course of 10 weeks for neck pain relief, but your insurance company may pay only for 25 percent of the cost of half the treatments. The company may also pay only for certain acupuncturists or only for acupuncture performed by a medical doctor.
Some Types of Treatment Covered
Recent research supports acupuncture for the treatment of neck, back and shoulder pain, and you may have more success in getting your insurance provider to pay for such treatment than for rehabilitation from a stroke. Although some acupuncturists devote themselves to the treatment of recovering stroke patients, this use of acupuncture has not been thoroughly tested in clinical laboratories and is, therefore, less likely to be covered. For insurance companies, the bottom line is whether acupuncture is considered an effective treatment for the condition, and if it is cost-effective.
Acupuncture Clinically Tested
Several studies, including peer-reviewed clinical trials published in the "Journal of the American Medical Association" and "Journal of Clinical Oncology," point to the efficacy of using acupuncture in the treatment of neck, shoulder and back pain. And because the cost of traditional back pain remedies is so expensive--patients spent $85 billion in 2005--insurance companies find it prudent to test the effectiveness of acupuncture for back pain and to support the treatment if it is less costly. On the other hand, the use of acupuncture for fertility treatments may never be approved by insurers even if studies proved it to be 100 percent effective because if you become pregnant, your insurance company would face the costs of your prenatal care, childbirth costs and medical care for your child. Since pregnancy is cost-prohibitive for insurance companies, they have no motivation to help you conceive.
Discover Coverage Limits
Another way to sort through the confusion of determining for what your insurance company will pay is to visit a reputable acupuncture practice and ask if they accept medical insurance. If they do, ask if they will check your insurance policy for you and tell you what, if any, treatment your company will cover. An acupuncturist who regularly handles insurance claims may be able to answer many of your questions upfront or, if not, find out directly from your insurance company what coverage it provides.
Precautions
If you choose to let an acupuncturist do your detective work for you, first find out if your insurance company limits its coverage to certain providers. If so, begin with a list of approved acupuncturists and ask one or more of them to help you determine your level of coverage. And if you seek alternative health care treatment, consult with your medical doctor before discontinuing any currently prescribed treatment. Also, the effectiveness of acupuncture continues to be debated among doctors and scientists.
References
- Centers for Disease Control.gov. Health Insurance Coverage
- "The International Herald Tribune"; Still debating benefits of acupuncture; Western researchers seek definitive proof that it is more than a placebo; Tare Parker-Hope; Aug. 26, 2010
- "New York Times"; Acupuncture and Neck Pain; John O'Neil, July 22, 2004.
- "Drug Week"; Clinical Trial Research; Memorial Sloan-Kettering Cancer Center, Department of Medicine reports research in clinical trial research; June 11, 2010
- "Journal of American Medical Association"; Real and simulated acupuncture appear more effective than usual care for back pain; May 29, 2009, p. 1838
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