Paying For CAM Therapy: The Basics

$33.9 billion.  That’s how much adult Americans spent over a recent twelve month period on CAM treatments.  These were out-of-pockets dollars.  $33.9 billion!

How did the spending break down?  According to a National Health Interview Survey (NHIS), we spent some $22.0 billion on self-care costs, for CAM products, materials and classes.  The other $11.9 billion was spent on visits to CAM practitioners.  And these billions accounted for only tiny portion – some 1.5% – of the total health care spending for that same twelve months, and about 11.2 percent of the total out-of-pocket health care spending in the US for that same period.

Most of us pay for CAM treatments on our own, out-of-pocket, without any help from health insurance.  Health insurance plans do cover some CAM services, however, or cover some portion of the costs, and more and more insurance carriers are designing plans with increased CAM benefits.  They are recognizing that we want access to these services and the science is starting to support some treatments.  Still, we generally pay for complementary and alternative treatments ourselves; the NHIS also reported that about a third of the uninsured respondents under age 65 used CAM.

Thinking about using a particular CAM service?  Before your treatment begins, be sure you understand how the payments work.  Some good questions to ask:

  • What will all this cost? How much is the initial consult?  What will follow-up visits cost?  How many sessions or appointments will I be likely to need?
  • Are there any additional costs?  Will I have to pay for additional testing, supplements or equipment?
  • Are there any payment plans or options? Can I arrange a payment plan over time?  Does the practice offer a sliding-scale fee (fees based on income and ability to pay)?
  • Do you accept my health insurance plan?  Do you have any experience with my particular plan’s coverage for someone with my condition?  How are claims taken care of?  Do I file the claims, or does the practice take care of this?
If you have an employer-sponsored health insurance plan, you are more likely to have access to CAM coverage than you would be with standard individual coverage, but the benefits may be limited.  Sometimes only certain therapies – massage, acupuncture, chiropractic – are covered, or partly covered, and other restrictions may apply:
  • Deductibles and/or co-payments.  These may be higher than those applied to conventional care.
  • You may need pre-authorization or a referral from your primary care physician.
  • You may be limited to an approved provider network.
  • There may be limits on the number of visits or the annual dollar amount paid.
There are employer-sponsored plans that offer CAM coverage by allowing employees to purchase CAM ‘riders’ along with the standard coverage.  There are also discount programs which let plan members pay for CAM treatments and services with participating providers at  pre-negotiated discount rates.  For some good basic information about employer health plans, check out this US Department of Labor site: USDOL
To find out more about your own health insurance plan’s coverage of CAM treatments, start by studying your policy.  Understanding a health insurance plan is no easy feat, by the way.  If you have any questions – and you will – check with your agent, or call the insurance company‘s customer service department directly.  Some questions to ask before you decide about having a CAM treatment include:
  • Is this treatment covered for my health condition?
  • Does this treatment need to be pre-approved or pre-authorized?
  • Does this treatment need to be ordered by a prescription?
  • Do I need a referral from my primary physician?
  • Do I have to see an in-network provider to be covered?
  • Do I have any coverage for an out-of-network provider?
  • What are the limits or requirements?  How many visits are covered?  How much will you pay?
  • How much will I have to pay out-of-pocket?
Note Well:  Document, document, document.  Whenever you call an insurance company, but particularly when finding out about coverage, be sure to take notes.  These notes should include the time and date of the contact, and the name and extension number of any and all representatives or associates you talk to, and the details of any conversations.  If they assign you a case number or an inquiry ID number, write it down.  Keep copies of all bills, claims and letters from the carrier, too.  Should you ever have a dispute about a claim, these notes will really help your cause.  And keep asking your questions until you are comfortable that you understand exactly what is, and what is not, a covered treatment or therapy.
Finally, there are two kinds of tax-exempt accounts that really help us save money for health expenses and could help with CAM expenses:
  • Flexible spending account: This is an employer-offered benefit.  An account is established which allows you to set aside pretax dollars each pay period to use to pay health-related expenses.  
  • Health savings account: This is an account that you, rather than your employer, establish to go along with a high-deductible health plan.  Again, you are able to set aside funds to pay for health-related expenses on a tax-favorable basis.
Check out this site for more information: Tax-favored health plans.  And some CAM expenses may be tax-deductible (in 2009, for example, deductions were allowed for acupuncture, chiropractic services and osteopathic care).  For more about this, go to IRS Publication 502.

2 responses to “Paying For CAM Therapy: The Basics

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