Monthly Archives: March 2015

A Report on the Use of Alternative Medicine

US News and World Report-March 9, 2015

About a third of U.S. adults use some form of alternative medicine, and most of them likely pay for it out of their own pocket. Alternative methods -- from supplements to acupuncture -- are used in preventive care as well as the treatment of chronic and acute conditions, but they often aren't covered by health insurance.

There isn't one reason why people choose alternative approaches over traditional medicine. One study published in Social Science & Medicine found that patients who choose a homeopath over a general practitioner are likely to do so because of "disenchantment with, and bad experiences of, traditional medical practitioners." Another in the Journal of the Medical Association suggested that people were motivated more by personal values, beliefs and philosophical attitudes about health.

Regardless of these findings, one thing is clear: Americans aren't flocking to alternative medicine to save money.

The Cost of Alternative Medicine

Americans spent more than $33.9 billion out of pocket on alternative and complementary medicine in 2007, the latest year for which comprehensive federal data are available. That amount includes visits to providers such as chiropractors and massage therapists, as well as products like supplements. While alternative medicine accounts for only about 1.5 percent of total health care spending in the U.S., it comprises 11.2 percent of total out-of-pocket health care spending, according to the 2007 National Health Interview Survey.

There's a perception is that alternative medicine is growing in popularity, with numerous websites dedicated to "natural health" and home remedies. But the research disputes this. According to an analysis of the Medical Expenditure Panel Survey from 2002 to 2008, the use of alternative medicine and spending on these services plateaued -- something blamed in part on the higher proportion of out-of-pocket costs.

Alternative Medicine and Insurance Coverage

When considering reimbursement, the Affordable Care Act mandates that insurers not discriminate against licensed health care providers, including those who practice alternative medicine, such as naturopaths, massage therapists and acupuncturists. But that isn't the same as requiring coverage.

Health insurers can limit coverage they deem experimental or not medically necessary, and they often do. Aetna, for example, says it considers alternative interventions medically necessary only "if they are supported by adequate evidence of safety and effectiveness in the peer-reviewed published medical literature."

So while such things as acupuncture, biofeedback, chiropractic care and electronic stimulation may be covered under their policies, music therapy, aromatherapy, therapeutic touch massage and a long list of other interventions are not.

Even when services are covered by an insurance plan, the insurer may require a statement of medical necessity or prescription from a primary care doctor. The coverage may also provided limited visits or cover only some of the services the provider offers.

Knowing Your Coverage Details

Health insurance coverage for alternative medicine is a mixed bag, varying from policy to policy. Your best bet is to make some phone calls and ask the right questions before making an appointment with a practitioner.

1. Call your insurance company. Ask your insurer the following questions:

-- Am I covered for this treatment?
-- Do I need a referral or prescription from my general practitioner?
-- Will I have to meet a deductible or pay a copay?
-- Am I limited to a certain number of visits?
-- What are some local providers in my policy network?

Make sure you write down who you talk to and what they say, should any coverage issues arise down the line.

2. Contact local providers. Next, call treatment providers, making sure to discuss the insurance plans they accept and their rates. Some alternative therapies, like chiropractic care, tend to cost more for initial visits than they do for follow-up appointments. Get a good estimate of how many visits you'll need to reach recovery or a point where returning won't be necessary.

3. Find out about additional costs. Ask your insurance representative and providers whether there are any additional costs you should know about. If, for example, your provider recommends that you add supplements or if your insurance company covers one treatment but not another, unexpected limitations and add-ons could come with a hefty price tag.

4. No coverage? Negotiate. If your health insurance doesn't cover the services you want, see if the treatment provider is willing to negotiate. Practitioners may be willing to put you on a payment plan or offer discounts to cash-paying customers.

Like most Americans who opt for alternative health care, you'll be paying out of pocket for at least some of your costs. Knowing just how much you'll be charged can help you budget for them ahead of time.

Ask the Expert: Charging for Missed Appointments

Question: I have had recent rash of patients missing appointments and I am hoping there is code to bill for these missed appointments?

Answer: Unfortunately there is no CPT code for “missed appointment.” It is not a billable or reimbursable service (or non-service, as it were) from any insurance carrier. However, an office is not precluded from billing a patient for a missed appointment. In fact, charges for missed appointments are very common among all health care professionals. Dentists, in particular, typically have strict policies on missed appointments and will charge patients when they miss or at least do not notify or reschedule within 24 hours of the appointment. Policies like this are more common than uncommon. The fear of the charge generally will influence a patient to not miss the appointment or, at the very least, contact the office timely to avoid being charged. The latter is in reality what most offices would prefer as they have the ability to schedule another patient for that time.

If you wish to start implementing a missed appointment fee there are few things that should be done to avoid confusion and misunderstanding. Patients must be informed at the time they schedule the appointment that there is a specific policy about missed appointments. It would be best for it to be posted in a conspicuous place, available to read at the time, or, at minimum, given verbally. This should be part of office protocol and followed in the same manner with each patient so the office can ensure that the patient was clearly informed and cannot later state they were not “aware.” Note the burden of proof that the patient was made aware is on the creditor (doctor). This would include costs and what constitutes a missed appointment, such as less than 24 hours’ notice.

Remember, it is not so much that the doctor wants the fee (note the fees for missed appointment are minimal $20-25 typically, and not at the full price of the services that would have been provided) but simply wants the patient to respect the professional status of the services and the office.

Many offices are elastic in implementing the policy and may even forgive payment for those patients who have a valid excuse or other issues that were precedent. A patient whom has had the fee forgiven may likely be more respectful after a favor has been afforded and feel a greater sense of obligation to the office in the future. Though it could go the other way, it is best to remember why the policy is there: not to collect a fee but to ensure compliance. If a patient does not comply, at least we know to not schedule them and exacerbate it further.