If you seek nontraditional health care, such as integrative or complementary approaches, does insurance cover it? Although the vast majority of such services are paid out of pocket, there are some exceptions and signs of change for the future.
“I know that there is a trend in that direction, when you’re talking about integrative medicine and a doctor who agrees that your mind, body and spirit all need to be treated at the same time,” says Myrna Harris, chief executive officer of Crescent Health Solutions in Asheville, a health-plan administrator for employers and several thousand employees in Western North Carolina and Oklahoma. “I think we are more aware of those things and that more is being done in those areas than ever before.”
But she sees two main reasons why there has not been more progress. “There is not enough data out there to support whether one of these integrative methods is effective enough. … When insurance companies or employers go to pay for something that is related to your health care, they would like to know that the literature is out there to support what is being done, that it has some efficacy,” she says.
“But then I believe that employers and health care have been so caught up in the confusion of what we’re required to do because of the Affordable Care Act, there has not been as much focus on integrative medicine as maybe there would have been.”
The ACA, for many people, means the procurement of basic health care. “Most people want a ticket to dance. That means they want to be able to get into a hospital if they need it and have peace of mind around basic care like annual exams,” says John Daly, owner of Insurance Value Management, an Affordable Care Act broker. If a person is healthy, he says, “I recommend that person into a high deductible [plan] so they minimize their premium.”
This strategy enables people to better afford services out of pocket.
In order to provide more coverage for integrative services, some employers have what is called a self-funded or partially funded insurance plan, whereas the big insurers — like Blue Cross Blue Shield and Aetna — have preset service menus and don’t include integrative services, says Harris.
Mission Health, for example, covers acupuncture for its employees through their self funded plan. “I think as a health system we have always seen the value of complementary therapies,” says Anna Walz, director of system wellness at Mission. “Certainly over the past few years it’s been more of a focus, and there’s more data in this area,” she says, referring to the growing scientific evidence supporting integrative therapies.
Mission employees have access to on-site massage, acupuncture, yoga and Zumba classes as a part of their My Healthy Life employee program. Interest in the program has been so strong that this March, it’s moving into a new facility, which will also be open to the public. “The goal [of the new location] is to create a peaceful, spa-like place for employees and the public to receive services. We want to work with people to prevent them becoming patients,” Walz says with a chuckle.
But even with the discounts Mission employees receive, a good portion of the fee for these services still comes out of pocket. One way to help make these costs easier is a tax-deferred bank account.
“Some employers offer flexible savings accounts,” explains Harris. “What this means is that employees can, for example, take $50 out of their paycheck every two weeks and put it into a flexible savings account. This is pretax money. They can then use those dollars to pay for certain things, like co-pays for doctors and medication,” she says.
The rules on what this money can be used for differ from plan to plan. At Crescent, which has the option of flexible savings accounts, you do not need a doctor’s prescription for acupuncture, but you do need one for massage, she explains.
Another option is a health savings account. “These are essentially a slush fund that you put in a participating bank. It is so much money per year that is tax-deferred, so you’re not paying taxes on it,” says Daly. Health savings accounts can be used “on any health services not covered by your plan until you meet your deductible,” says Daly.
Health savings account funds can used for any integrative and preventive care service.
In addition, many Asheville integrative and holistic health care providers go out of their way to design fee structures that are accessible. “The most progressive thing I’ve seen here in Asheville is a $40 [per] month deal,” says Daly.
He is referring to Integrative Family Medicine of Asheville’s Integrative Living Program. For $40 a month, a patient receives a number of benefits, including an annual physical exam, unlimited visits for a $20 co-pay, $30 discount on all procedures, and standard labs at no cost.
“The average physician spends $80,000 a year to interface with insurance,” says Brian Lewis, one of the founding physicians at the practice. “We looked for a way to set up primary care that is affordable for people.”
So Integrative Family Medicine settled on the flat monthly fee structure, a feature of an emerging financial model called direct primary care. “It takes the barrier away to spending time with a provider,” says Lewis.
Even though most integrative care, tax-deferred or not, is out of pocket, many people find a way to afford it. “I see a significant number of people who don’t make a ton of money, because they see the value,” says Nancy Hyton, a licensed acupuncturist and owner of Center for Holistic Medicine. “I have people [come here] who work at gas stations, wait tables. West Asheville is not a wealthy neighborhood, but we’ve been here eight years, and that’s really the core of people who come to see us, people in the neighborhood. They’re not loaded, but they think it’s worth it, they feel better, they get results,” she says.
“And more and more [acupuncture and massage] is being prescribed. If your doctor prescribes it, it might be covered by insurance. A lot of people don’t know that.”
“It’s hard to say,” says Lewis when asked what’s in the future for insurance coverage for integrative medicine. He looks at trends. One is the growing amount of science supporting the efficacy of these approaches, he says. Another is the possibility of the creation of a specialty in integrative medicine, which would enable integrative medicine doctors to be covered under most insurance plans.
Harris sees a wider picture. The big question for her? “Can insurance cover [these services], and if so how much, versus how much does the employee and individual take on? I believe as individuals we need to begin to take more responsibility for our health and well-being. And that means we have to have more skin in the game, if we can afford it.”
And although Harris knows that some people cannot even afford copays, for those who can, “We need to be able to do something ourselves” she says, “so that it is not just all handed to us. When we have some investment in what we’re doing, I think that motivates us.”
Myrna Harris, crescenths.com or 670-9145
John Daly, insurancevaluemanagement.com or 808-2584
Ann Walz, mission-health.org or 213-1111
Dr. Brian Lewis, integrativeasheville.org or 575-9600
Nancy Hyton, centerholistic.com or 505-3174