For an increasing number of Americans, the search for good health care has come to include a broad range of treatments, many of them well outside conventional medical practice.
According to a study reported in The New England Journal of Medicine in January of 1993, an estimated 425 million visits were made to alternative-medicine practitioners in 1990, compared with 388 million visits to primary-care physicians.
In addition, 34 percent of Americans reported using at least one form of alternative care in 1990, spending a total of $10.3 billion in out-of-pocket expenses.
Until recently, insurance companies have been reluctant to cover alternative medicine-which can include such diverse therapies as acupuncture, homeopathy, various forms of bodywork and traditional Chinese medicine-on the grounds that not enough scientific research has been done to confirm its effectiveness.
But there are signs of change. Some states, including Illinois, now require private insurers to cover acupuncture, and the National Institutes of Health has established an Office of Alternative Medicine to investigate the claims of various therapies.
Some insurance companies, such as Prudential, cover acupuncture for the treatment of chronic pain. Others have gone further. Mutual of Omaha, for example, recently established a program for reversing heart disease, based on the research of Dr. Dean Ornish, director of the Preventive Medicine Research Institute in California. Participants in the three-month program eat low-fat vegetarian diets and manage stress through meditation and relaxation techniques. For those who believe a visit to a Chinese herbologist is more beneficial than a trip to the neighborhood pharmacy, there are several methods for finding coverage.
For instance, a number of HMOs are starting wellness plans that combine physical and mental health services, more popularly known as mind-body therapy.
“Because HMOs are not as tied to the traditional fee-for-service system, a primary-care doctor has more flexibility in deciding whether an alternative therapy would be a good idea,” said Donald White, spokesman for the Group Health Association of America, a trade group for HMOs.
Some in the health-care field also believe that alternative therapies are more cost effective, particularly for chronic health problems, than some conventional treatments.
That’s a belief shared by Mary Fedak, director of the provider network for the Wellness Program, a policy provided by American Western Life Insurance Co. in Utah. Fedak estimates the savings can range between 30 and 80 percent.
Once subscribers enroll in the plan, they’re given a packet of educational materials along with their enrollment information and coverage, and they’re also given a directory of providers in their area.
“They’re encouraged to go for a natural wellness visit with someone on the network that we have designated as a wellness doctor. That person could be an M.D., or it could be a doctor of Oriental medicine, or it could be a chiropractor who has gone for training and expanded her scope of practice.”
At that first meeting with the doctor, subscribers have a detailed health history taken and are often given suggestions on what kind of lifestyle changes might be needed. From then on, when a policyholder wants to see a physician, he or she must call an 800 number that is staffed with naturopathic doctors who answer questions and give advice.
“These doctors are kind of like gatekeepers,” Fedak said. “They would not deny care to someone, but they discuss and give guidance on what kind of practitioner the caller should see. They also give a visit number, which is a tracking number for us. They don’t diagnose or prescribe on the phone, though they may give some suggestions that the patient can use for self-care.
“At that point, it’s up to the caller as to what kind of therapist they want to go to for treatment.”
Along with providing coverage for conventional health care, the Wellness Plan offers coverage for acupuncture, naturopathy, homeopathy, botanical medicines and many other forms of treatment. Deductibles range from $250 to $2,000, and pre-existing conditions will not be covered until you’ve been enrolled in the program for two years.
“The main concept is that people take responsibility for their own health,” Fedak said. “And it’s up to us to empower and educate them so that they are equipped to take that responsiblity and make intelligent choices about what they need for their health.”
There are also plans that combine coverage of alternative and conventional medicines. The Alternative Health Plan allows freedom of choice for such treatments as acupuncture, naturopathy, homeopathy, message therapy and others.
Steve Gorman, president of the company, says he set up the plan to help provide alternative health insurance coverage for individuals and groups.
“We’ve put together a collective bargaining contract with (the Professional Craft and Maintenance Employees in Chicago) to allow members of our health care-purchase cooperative to have access to their health and welfare fund,” Gorman said. “The reason we did it this way is that insurance companies are just so spotty in how they cover alternative treatments.”
Gorman, who says that his plan is used by the National Organization of Women, among others, says his plan offers the same benefits as a conventional plan, such as hospitalization and X-rays, but, according to its prospectus, it also covers access to “any licensed physician acting within the scope of their license, both office and hospital visits, to treat any illness or injury or to provide preventive services.”
There is a one-year waiting period for pre-existing conditions and there is no age restriction. It also provides named partner coverage regardless of marital status or sex.
In Chicago, the cost would be $137 per month for somebody in their 30s with a $1,000 deductible. The plan pays 80 percent of the first $5,000 in expenses and 100 percent therafter. Gorman says the cost of the plan is not out of line with traditional insurance policies and will probably come down in price as more people sign on.
