You know you’re covered for your annual physical and your teen’s visits to the dermatologist for his acne. But what you don’t know about your coverage could hurt you.
You could be missing out on some great benefits that don’t fall under the guise of conventional medicine. Policies will vary from employer to employer and state to state, says Cynthia Michener, a spokeswoman for Aetna Healthcare. But today a growing number of health plans (well-known and small) now cover alternative and complementary therapies that have been scientifically proven to be safe and effective.
First, 10 things every health insurance plan has
All plans that comply with the Affordable Care Act are required to offer, at minimum:
- Outpatient care
- Emergency services
- Hospitalization (such as surgery)
- Pregnancy, maternity, and newborn care
- Mental health and substance-use disorder services, including counseling and psychotherapy
- Prescription drugs
- Rehabilitative services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care. But dental and eye care is not mandatory for adults.
Your state may require additional benefits. And on top of that, extras can vary from company to company. Here’s a sampling of coverages you might not expect to find, whether you buy your individual health plan directly through the top health insurance companies or through the health care marketplaces, the only way to get a subsidy. (See “2017 open enrollment: 10 essential facts”)
More insurance companies are adding acupuncture and related services to their lists of covered services. Those that cover acupuncture do so for conditions where it has been scientifically proven to have benefit. Those have included: pregnancy nausea, post-operative dental issues, nausea and vomiting that is the result of chemotherapy for cancer and for chronic conditions including migraines, osteoarthritis and back pain.
One insurance company that seems to embrace the idea of acupuncture is Cigna Health. It offers coverage for acupuncture in many states. California MediCal offers limited coverage for acupuncture, too, as long as you see an acupuncturist who is a MediCal provider. If your health insurance company doesn’t cover acupuncture, ask if it has an affinity program that can help pay the bills. Affinity programs allow you to select providers at a 20 to 40 percent discount. If you want coverage, your doctor will have to write you a prescription for acupuncture.
Everyone knows staying in shape is key to good health. If you go to the gym on a regular basis to work out, your health insurance may help foot the bill for that reason.
UnitedHealthcare offers $20 toward your gym membership every month you go 12 or more times for a total of $240 a year. Present your health insurance card at the Y or certain fitness centers including Curves, LA Fitness, Gold’s Gym and some independent locations and your money will be deposited in your bank account or credited toward your membership dues. The option is available in 24 states to covered employees and their covered spouses who are enrolled in a participating UnitedHealthcare Small Business insurance policy.
If you have an individual or family plan through Presbyterian Health in New Mexico, you and your covered dependents are eligible for free memberships at more than 8,500 national, regional, and local fitness, recreation and community centers.
Get your physical therapist, chiropractor or osteopathic physician to prescribe massage therapy for your chronic back pain and you may get your health insurance to cover at least some of your sessions.
Some Blue Cross Blue Shield of Massachusetts plans offer subscribers a 30 percent discount on their massage therapy sessions as long as they use a BCBS network provider. Some Aetna Healthcare plans also offer their subscribers discounts on massage therapy sessions.
As with any alternative or complementary therapy, the number of covered or discounted sessions may be limited. Check with your insurance provider before you go.
Reiki is a form of healing that started in Japan in the 1920s. It involves the practitioner laying his hands just above your body or lightly touching it. Positive energy flows from the Reiki-trained practitioner to the patient. Reiki is used to help everything from head or stomachaches to side effects of cancer treatment, fibromyalgia and depression. Reiki is gaining in popularity in the West, and a few insurance companies are willing to help with the cost — usually about $25 to $100 a session.
For sessions to be covered or discounted, Reiki likely has to be woven into a treatment plan that includes physical therapy, massage therapy or palliative care and delivered by a nurse or licensed professional during your hospital stay.
5.Fitness training, yoga, tai chi and Pilates
If you want to work one-on-one with a personal trainer at the gym or at home for your medical condition, you may be eligible for some coverage, depending on your plan.
One example: Based in Seattle, Group Health Cooperative offers a Complementary Choices program that you can add to your health insurance and that will provide coverage/discounts for sessions with personal fitness and exercise trainers, and yoga, tai chi and Pilates classes. Group Health serves more than 600,000 residents of Washington and North Idaho. To qualify for the discount on these services, you must use a provider in its Complementary Choices directory. Not all services are available everywhere but its list of network providers is growing.
Alternatives payments for alternative therapies
If you don’t have insurance coverage, you may be able to use the money in your Flexible Spending Account (FSA) to pay for these complementary and alternative therapies as long as you can prove they are medically necessary. For example, you can be reimbursed for the fees you paid your personal trainer if you have a doctor’s note that recommends you work with one for your medical condition. Same with acupuncture and massage therapy. All you need is a letter from your health-care provider that says it’s a medical necessity.
You may have to pay for your massage or Reiki upfront and submit your claim to your health insurance plan along with your letter of medical necessity (LOMN) and get reimbursed. (See “12 ways to save on your health care costs.”) Most practitioners don’t have the insurance codes they would need to submit your claim on your behalf. Costs for these services can vary widely depending on where you live and the practitioner you choose. Whether or not you have coverage or a discount, ask how much you will be charged before making your appointment. If you have coverage, ask your insurer how many sessions you are entitled to and exactly how much your coverage will pay for.