You've read the article. Now tell us what you think.

For more information

By Cathryn Domrose
April 13, 2000
Photo: Corbis

When Maggie Lauer injured herself in a car accident a few years ago, her mother suggested she try acupressure. Normally Lauer, then a student, wouldn’t have considered it. She had little money to pay for such a treatment. But she was insured under her mother’s health plan, which covered acupressure with a $20 per visit co-payment.

"It worked wonders," Lauer said. She was so impressed that when she began working as a public relations assistant at the Good Samaritan Regional Medical Center in Phoenix, she chose to pay a little more for a health package that included alternative care practices.

According to a recent study by Kenneth Pelletier,PhD, MD, director of the complementary and alternative medicine program at the Stanford University School of Medicine, consumer demand is pushing more insurance companies to consider offering coverage for alternative or complementary medicine. Services most commonly covered include chiropractic and acupuncture. Other plans may cover therapies such as massage, homeopathy, naturopathy, stress management and meditation, herbal remedies, and traditional Chinese medicine.

"Not everyone is interested," said Kathy Lauer, Maggie’s mother and the system administrator of total compensation for employees of Banner Health Arizona. The Banner plan helps pay for chiropractic, acupuncture, acupressure, and some massage therapies. "But it gives an appropriate choice to our employees. A lot of people felt that [alternative therapies] were an alternative to taking a lot of medications."

According to Pelletier’s study, published last July in the American Journal of Health Promotion, nearly half the adults in the United States have used complementary or alternative therapy. Most paid for the treatments out of pocket. But in the last several years, either in response to requests from plan users or because of state laws requiring them to do so, some companies have started covering alternative therapies if they are performed by licensed practitioners.

Blue Cross/Blue Shield of Illinois allows patients to choose a chiropractor as their primary care physician. Blue Shield of California gives members a discount on alternative services, including acupuncture, chiropractic, massage therapy, and stress management programs. Health Net of California’s plan offers access to an acupuncturist, who also can provide massage therapy and herbal remedies, according to Pelletier.

Insurance companies and HMOs that offer alternative and complementary medicine coverage usually work with physicians and nurses who also are alternative care providers or who include licensed acupuncturists, chiropractors, or other therapists in their medical group. Most policies cover treatments only if they are deemed medically necessary, and most limit the number of treatments.

State laws usually require insurance providers to work only with licensed providers, which limits services covered. A state may license acupuncture and chiropractic, for example, but not massage therapy. Other states mandate reimbursements for various alternative treatments such as acupuncture, osteopathy, and chiropractic.

Those who study alternative and complementary medicine say there are many questions to be answered before such coverage becomes standard.

"The first thing is what is alternative medicine?" said Richard Gracer, MD, a family practice physician in San Ramon, who specializes in chronic pain management and nutritional problems. "How do you decide what services are appropriate?"

Increasing insurance coverage of alternative therapies may force more alternative practitioners to become accredited, a good thing for everyone, said Gracer, who practices nutritional medicine and often prescribes herbal remedies and vitamins for his patients. But many alternative services focus on wellness and the whole person and do not lend themselves to the double-blind, controlled tests favored by traditional medicine. This is one reason physicians as well as insurance companies are skeptical of them.

"There needs to be a great deal more research on clinical efficacy and cost outcomes in order to responsibly incorporate complementary and alternative medicine into mainstream health care," Pelletier said.

Separating legitimate alternative therapies and practitioners from dangerous or useless ones is part of the challenge for Carole Rogers, MPH, RN, CEO of Bienestar-California. Bienestar, which also has branches in New York, New Jersey, Connecticut, and Florida, is a for-profit, alternative health program that offers access to alternative care providers. Bienestar checks practitioners’ credentials and makes sure they have malpractice insurance, then provides referrals to its members. Some practitioners offer a 20 percent discount to members.

Bienestar plans to offer its own insurance, perhaps similar to a dental insurance plan, covering 80 percent of the cost of alternative therapies, Rogers said.

"I think more people are looking for answers that aren’t part of the pharmacopoeia," Rogers said. "We’re not trying to replace traditional medicine. I want to see a good oncologist if I have cancer, but I also want to see what other options are available."