Alternative-Treatment Trend Raises Insurance Issues
Americans by the millions are treating themselves with herbal potions, acupuncture, massage and other therapies outside the world of traditional medicine.
Are they being smart and safe consumers?
Sometimes, but not always. The reality is that there is a lot that is not known about the effectiveness of various alternative therapies. Despite growing demand for these services by the public, and the eager response of the insurance industry to meet that demand, the verdict is still out.
Your spouse or neighbor may be singing the praise of alternative treatments, but you should approach them with caution. Remember that the scientific gold standard is the clinical trial: Researchers test the effectiveness of a treatment on two groups of people, one that actually receives the treatment or compound and one that does not. They then determine if there is a difference in the health results between the two groups. This is the test before any new prescription medication goes on the market in the United States.
Not so for the shelves of herbs, pills and dietary supplements at your local pharmacy or natural food store. They are marketed without any of the scientific proof of effectiveness that the Food and Drug Administration requires before prescription drugs are allowed on the market.
We should know a lot more about what works and doesn’t in three or four years, when a flood of data will come from trials being conducted at medical centers across the country under the direction of the National Center for Complementary and Alternative Medicine. The federal agency, a division of the National Institutes of Health, has a research budget of $90 million.
Until then, consumers must ponder many decisions and questions: Do I believe the treatment is safe without formal evidence? Is it worth looking for health insurance that provides some coverage for alternative therapies, or am I better off paying out of pocket? Even when all these decisions are made, and the consumer decides to pursue an alternative therapy, it is vital that the consumer’s regular medical doctor stay informed. Some herbs and dietary supplements can interact with prescription drugs, posing a health risk. Most of the time “patients don’t tell and we don’t ask,” said Dr. Harley Goldberg, director for complementary and alternative medicine for the Kaiser-affiliated Permanente Medical Group in Northern California. “The main message is ‘talk to your doctor,’ ” he said.
You should never be embarrassed or hesitant to tell your physician that you are seeing other health practitioners or taking nontraditional medications. And doctors should do a careful and diplomatic job of learning about what patients are doing.
“It is vital to elicit a comprehensive history and find out every other therapy the person is undergoing,” said Dr. Dexanne Clohan, who oversees medical networks for health insurance giant Aetna in Orange, Riverside and San Bernardino counties.
“You’ve got to encourage patients to be candid, to talk about whether they are taking herbs they received from outside the country,” she said.
The popularity of alternative medicine poses a big dilemma for health insurers involving how to reconcile two potentially conflicting goals: the necessity to pay only for therapies with a scientifically proven benefit, and the economic incentive to give patients what they want, what sells.
“One of the dilemmas is knowing what is safe and effective,” said Dr. Charles M. Cutler, chief medical officer for the American Assn. of Health Plans, an HMO trade group. “That’s what leads to limited coverage.”
Chiropractic seems to have moved in the mainstream of coverage, with most health insurers offering at least one plan that covers chiropractic visits. Typically, they are capped, perhaps at 12 or 20 treatments in a year. “The public is saying, ‘I want to move in this direction, and insurers and employers are responding to that,” said Pat Jackson, vice president for professional development and research at the American Chiropractic Assn.
However, the scientific researchers have yet to give their blessing to chiropractic as a valid treatment proved by clinical trials. With consumers insisting that it does work, employers have been moving to make it available to employees.
The insurance industry also has responded to the popularity of alternative medicine. Blue Cross of California, a large health insurer, is waiting for state regulators to approve an “ultra premier” policy, offering all the regular doctor and hospital coverage, plus lots of extras: 24 visits a year to an acupuncturist, $300 worth of massage treatment, $300 toward a health club membership and $500 for any herbal medicines. The policy would cost $300 a month for an individual, about double the cost of a typical policy in the Los Angeles market.
Blue Shield of California has arranged for a list of alternative practitioners--from massage therapists to somatic education programs--that offer a 25% discount on their customary fees. The company doesn’t cover their services as part of regular health insurance.
Aetna has a 2-year-old “natural alternatives” program, with a list of more than 7,000 providers in 37 states, offering a plethora of services, including massage and nutritional counseling. Aetna members get discounts on acupuncture, massage and nutrition counseling. Customers also can order products for exotic treatment methods such as aromatherapy, biomagnetics and flower essences. Aetna says the alternative provider information on its Web site gets more “hits” than any other part of the site, including medical doctor and hospital lists.
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Bob Rosenblatt welcomes your questions, suggestions and tips about coping with the changing world of health care. Send questions to Bob Rosenblatt, Health, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053, or by e-mail to bob.rosenblatt@latimes.com. Health Dollars & Sense runs the second Monday of each month.
