Is your alternative therapy covered?

By SmartMoney

Doctors just couldn't figure out what ailed Rowena Chodorow.

At the ripe age of 33, Chodorow felt tired all the time, had trouble sleeping and seemed to be allergic to just about everything. Immunotherapy didn't help, nor did other treatments.

"I wasn't getting the help I needed from mainstream medicine to feel better," recalls Chodorow, now in her late 50s. So she started shelling out money for alternative therapies such as herbal supplements, chiropractic adjustments, naturopathy and acupuncture, all of which helped her to feel better physically. However, because none of the therapies were covered by her insurer, they had a sickening effect on her finances.

Chodorow's primary-care physician eventually diagnosed her with chronic fatigue syndrome. Battling her cyclical symptoms over the years, the Austin, Texas, native has paid several thousand dollars a year out of her own pocket.

"When you have chronic fatigue, you don't have the energy to put up a fight with the insurance company," she says.

But in a twist, Chodorow's insurers have grown increasingly amenable to covering treatments that were once taboo. Under her current plan with Aetna, her chiropractic visits get full coverage, and so does her acupuncture, as long as the practitioner works out of a qualified doctor's office. Her herbal supplements qualify as a valid health-savings-account expense.

Broader coverage

On a national scale, insurers are steadily broadening the types of services that receive coverage, from alternative medicine and mental health care to elective procedures such as gastric bypasses and vision-correction surgeries. Nearly 50% of plans included acupuncture in 2004, for example, compared with less than 20% in 2000, according to the Kaiser Family Foundation, a health research organization.

Consumer interest is the driving force; 75% of U.S. adults have tried an alternative treatment, according to Kaiser.

For employers, offering such options not only allows them to gain employee favor, but also helps alleviate rising costs, says Etti Baranoff, an associate professor of insurance at Virginia Commonwealth University. Gastric-bypass surgery costs are insignificant compared with the lifelong health-care toll of obesity, for example, and homeopathic remedies may improve allergies for a fraction of the price of prescription medicines.

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But the bite of rising health-care costs works both ways. Options may be broader, but that doesn't necessarily mean coverage is more generous. Rather than folding new treatments in as part of their medical coverage, employers are instead opting for the cheaper options of offering them as supplements (much like vision or dental) or offering discount programs, says Doug Gwilliam, the president of CBIZ Benefits & Insurance, a consulting firm. By doing so, however, coverage is much more restrictive. One misstep and you may end up owing the entire bill.

What you can do

Here's how to better improve your odds of getting the treatments you want covered by your insurer:

Scan your plan. Read the details of your coverage as set out in your employee handbook and your insurer's Web site. Look for limits on either the number of visits or the amount of money spent. You'll also need to find out whether you must use the entire benefit in one shot.

"If you stop the treatment, a lot of times they won't let you go back," says Rob Cola, the president of Brown and Brown Consulting, a benefits consultant. It's also common for insurers to require that a procedure fit a specific medical need. Medicare, for example, won't cover a gastric bypass if an obese individual merely wants to lose weight. He or she must be suffering from a life-threatening disease that would improve with weight loss, such as poorly controlled Type 2 diabetes or advanced coronary artery disease.

Also, don't forget to look for separate wellness offerings. Aetna, for example, provides 25% off on visits to select chiropractors, acupuncturists, massage therapists and dietitians, as well as 15% off wellness products such as vitamins and homeopathic and herbal remedies.

Continued: Leave a paper trail

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