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Health Insurance Coverage & Alternative Medicine

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By Acupuncturist Dr. Jeannette “Jett” Kerns, AP, DOM, L.Ac., St. Cloud, FL owner of East Lake Acupuncture

According to the National Center for Health Statistics, about a third of Americans use some form of complementary or alternative medicine (CAM). Americans spend more than $30 billion annually out-of-pocket on everything from acupuncture to Zyto scans. Despite those billions of dollars spent on CAM therapies, many are not covered by health insurance.

In the most recent study, most of these out-of-pocket expenses (over $14.7 billion dollars) went to CAM therapies such as acupuncture, chiropractic care and massage. We spent another $12.8 billion on natural products, and $2.7 billion on self-care approaches, such as wellness books and homeopathic medicines.

According to the National Institute of Health (NIH), the most commonly covered CAM therapies include acupuncture, chiropractic care and massage. Non-covered CAM therapies generally include herbs and supplements, homeopathy, kinesiology and naturopathy. Though these procedures may not be covered, alternative healthcare costs could be reduced if policyholders better understood insurance policies and options, taking advantage of covered CAM therapies.

Many self-insured plans (insurance through employers) offer coverage for a variety of CAM therapies; however, policyholders are often unaware of these benefits and don’t know where to look for coverage information. To make matters more complicated, insurance companies will often require diagnosis and procedure codes before they can confirm coverage.

Most CAM providers do their best to verify coverage in advance. However, we’ve had patients come to us from other clinics with stories of being hit with big bills later because their insurance company verified coverage or listed it in the policy manual but failed to mention coverage was limited to specific health conditions or was only partially covered. Having the correct codes handy when calling insurance companies and asking about specific restrictions is vital to proper verification, and even then, there are challenges.

No insurance coverage? One option for obtaining coverage for alternative medicine costs is through a Health Savings Account (HSA), Flexible Spending Account (FSA) or Healthcare Reimbursement Account (HRA). For more information on these options, visit: https://www.consumerreports.org/healthcare-costs/how-to-use-fsas-hsas-hras-to-cut-healthcare-costs/

We accept HSA, FSA and HRA payments at our clinic and for those without an account or insurance coverage, many CAM providers including our clinic, offer a variety of financing options ranging from interest-free payment options that do not require a credit check or revolving credit plans such as ParaSail™ or CareCredit™. 

In an effort to prevent surprise bills later, we hired a CAM billing expert. Our billing agent obtains advance coverage and restriction information on more than 10 CAM therapies, including acupuncture and massage. Whether you come to our clinic or wish to visit another and live or work in Osceola County, our billing agent will be happy to verify your coverage for CAM therapies at no cost or obligation. Simply visit our website at https://eastlakeacu.com/ and use Klara™, our secure, medical communication portal and texting app and request a VOB (Verification of Benefits).