Path to Alternative Therapies Is Littered With Obstacles
She researched other doctors and alternative therapies until she hit upon the Block Center for Integrative Cancer Care in Evanston, Ill., which uses an approach of traditional and holistic therapies to treat cancer patients.
So where is this anecdote heading? Glad you asked.
As a Patient Money columnist, I don’t pretend to have that expertise.
Instead, my purpose here is to provide financial guidance for those who, like Ms. Klenke, choose to take the medical path less traveled.
So-called complementary and alternative medicine — or CAM, as it is known by practitioners and adherents — is becoming more mainstream every day. In 2007, more than one in three adults and nearly one in eight children, according to a federal study sponsored by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, used some form of CAM — from self-prescribed nutritional substitutes to repeat visits to alternative health care practitioners.
So commonplace are the alternative providers that chiropractors and acupuncturists, for example, are now licensed by most states. At the same time, many traditional medical doctors, recognizing patients’ demand for alternative therapies, and have signed up for training in alternative therapies or added alternative professionals to their staffs.
Alternative medicine is also a big business. Americans spent nearly $40 billion out of pocket on alternative therapies, according to that same 2007 study, to pay for practitioners as well as vitamins and supplements. Often, the treatments aren’t cheap. A session at the acupuncturist can easily run $100. And also with pharmaceuticals, vitamins, herbal supplements and homeopathic remedies have a huge price range — from a $12 bottle of vitamins to supplements costing hundreds of dollars.
More insurance companies are now offering full or limited coverage, or arranging discounts, on these treatments. But, as Ms. Klenke learned, getting even limited coverage can be time-consuming and tricky.
And most people pursuing alternative therapies should expect to pay some, if not all, costs out of pocket, says Mark Stengler, a naturopath in the La Jolla area of San Diego who is licensed in California. Whom also holds a doctorate from the National College of Naturopathic Medicine, now called the National College of Natural Medicine, in Portland, Ore. Naturopathic training is often similar to the training conventional doctors receive and includes holistic training. Dr. Stengler is the author of several books and the Bottom Line newsletter on natural healing. If you venture forth, here’s advice on how to make the most of your insurance coverage and find the best prices for the highest-quality alternative treatments and medicines.
INSURANCE INS AND OUTS Before you do anything, be sure to read your health insurance policy thoroughly. It may spell out some of the alternative practitioners and treatments it covers, for example, 50 percent of all acupuncture and chiropractor visits.
More often, says Linda Bourdosis, a patient advocate at the Block Center, coverage is more subtle. For instance, your insurer may pay for certain specific treatments & massage therapy for muscle strains, for instance, or fish oil supplements to reduce inflammation from arthritis — if they are prescribed by your primary physician for a diagnosed ailment and coded correctly. Many require preauthorization from the insurer.
In her case, Ms. Bourdosis at the Block Center negotiated with her insurer, but sometimes the patient needs to be the middle man to get an insurer and health care provider to agree.
Or, you might want to try to find an alternative practitioner who is part of a larger group of traditional doctors, or vice versa, Dr. Stengler says. That way, if you need lab tests or other diagnostics, your primary physician can prescribe them and they will be covered — even if alternative treatments are not.
FIND AN ADVOCATE The insurance maze can be time-consuming and difficult, especially in the face of illness, Ms. Klenke acknowledges. But there is help.
Most large hospitals and clinics, especially those with integrative medicine programs, like Beth Israel in New York, have an advocate in the billing or coding department that can help with prequalifications, appeals and other paperwork.
If you have a major illness like cancer, your insurance company may have also assigned you a separate case manager. Ensure the advocate and insurance manager are talking to each other.
BUY ONLY WHAT YOU NEED If you swear by the chiropractor or acupuncturist but your insurance doesn’t cover the treatment, you’ll need to make some spending decisions.
One important caution from Dr. Stengler is this: Avoid paying upfront for a package of visits, say, 10 to 15. “If you’re not seeing improvement in two to three visits,” he said, “then that therapy probably isn’t right for you.”
Ask your practitioner if you can agree to only two or three visits, with the idea that you’ll continue the therapy if you see results.
CARE WITH SUPPLEMENTS A big part of alternative medicine is herbal and vitamin supplements. These are not as closely regulated by the Food and Drug Administration as prescription drugs and, as a result, there are many cases of supplements being sold with high levels of toxic substances or even prescription drug ingredients not listed on the labels. What’s more, many fraudulent brands sell high-priced supplements with minuscule dosages of the effective ingredient.
SHOP BIG BOX OR ONLINE. Once you’ve found a brand you know you can trust, compare prices. Chances are your local health food store isn’t going to have the best prices. Both Costco and Sam’s Club have started selling supplements aggressively in recent years, and many times they have the best deals.
In addition, try Web sites like Vitacost.com, says Dr. Stengler, which can offer products for 40 to 50 percent less than bricks-and-mortar retailers.
Think twice before buying directly from your practitioner, says Dr. Riley. Many doctors, he said, “make huge margins by selling supplements right in the office.”
The Patient Money column on Saturday, about ways to pay for alternative medical procedures and nutritional supplements, misquoted Dr. David Riley, a medical doctor who is editor of the journal Alternative Therapies in Health and Medicine. Dr. Riley said he was not aware of any mislabeling problems involving the nutritional supplement glucosamine. He did not say that a supplement promoted as supplying 100 percent of a daily dose of glucosamine might actually contain only a microscopic amount of the ingredient. The article also referred incorrectly to the Food and Drug Administration’s jurisdiction over nutritional supplements. The F.D.A. does in fact regulate nutritional supplements, although it does not oversee the supplements as extensively as it does prescription drugs.
Information on Insurance and Financial Assistance
We have started researching organizations that may be able to provide financial assistance, insurance, or help with flights to a clinic. If you are aware of other organizations that helps those with limited funds, please email us details at firstname.lastname@example.org.
Visionary Alternatives, Inc., a Florida not-for-profit, federally tax-exempt corporation was created to provide the opportunity for individuals with life threatening illnesses to receive the treatment of their choice.
They will help with the necessary funding for proven unconventional treatment when insurances are lacking and personal finances have been exhausted, or they may be able to get you into a clinic at a discounted rate.
The Cancer Coalition of America (CCA) is a nonprofit organization that provides grants to patients who can no longer afford the treatment that is helping them. Their goal is to ensure that when a patient is responding to a treatment—whether it be traditional, alternative, or experimental—funds are available if the patient no longer can afford to continue paying for that treatment. The CCA provides grants to patients for various aspects of care that health insurance does not cover. They provide assistance for people who are already in a program but who might have to quit the therapy because of a lack of funds.
More and more health insurers and HMOs are covering alternative therapies, including Blue Cross of Washington and Alaska, Blue Cross of California, California Pacific, Catholic HealthCare West, HealthNet, Kaiser Permanente, Mutual of Omaha, Oxford Health Plans, and Prudential. Be sure to check with your insurance provider to see if they now cover alternative therapies or if they plan to.
We understand that some insurance companies will cover some of the therapies listed on this site. We even understand that they will cover some clinics even outside the United States. For example, we heard that Klinik St George treated one patient for prostate cancer and their insurance picked up some of the charges. So it is worth checking. You should be prepared though that most clinics outside the US require cash upfront to begin treatment.
Medicare and Medicaid plans are accepted at some of the clinics in the U.S. If you do not have funds to pay for treatment and have been diagnosed with cancer, you can apply for medicare to help cover the costs. Then you can contact clinics or us to see if they will accept Medicare.
You may want to work with an insurance coordinator. One company is Health Insurance Claims Filing Services in Houston, Texas – Phone 713 937 1875 or Fax 713 937 1921. We understand many alternative clinics use them to help get your treatments covered. They do charge 10-15% of the monies recovered as payment. They have the experience and know the codes to use to get some of the alternative therapies approved, so you might want to consider using them.
Help with Flights to Clinics
There are a couple of organizations that will fly patients who can’t afford the airfares, but most have arrangements with conventional hospitals. We found one that will also fly to alternative hospitals. Contact The Air Care Alliance for details.