If you’ve tried acupuncture, therapeutic massage or other complementary and alternative medicine (CAM) treatments to ease your arthritis symptoms, you’re not alone. About a third of U.S. adults use some form of CAM therapy, at an estimated out-of-pocket cost of $30.2 billion in 2012, according to a National Health Interview Survey. This number represents only 1.1% of total health care spending, but it’s more than 9% of total out-of-pocket health care expenses.
Countless studies have shown that certain CAM therapies may help reduce the pain and disability associated with arthritis and related conditions, yet health insurance often doesn’t cover them. Here are some tips from industry experts to improve the chances that your insurance plan will foot the bill.
Call Your Insurance Company First
Ask if the treatment is covered for your condition, if it needs to be preauthorized and if you need a referral or a prescription. Find out if your insurance will cover your practitioner, whether there are any limits such as a maximum number of visits and if there is an out-of-pocket cost. Also ask if you’ll need to pay up front and then file with the insurer for reimbursement, says Sean McGuire, president of E.D. Bellis, a health care consulting company.
File an Appeal
If your insurance company rejects the claim, file an appeal. Keep a file about your treatment, including notes about calls and copies of bills and letters. Ask your doctor for a statement detailing the medical necessity of your treatment, and ask your CAM provider to supply evidence about the treatment benefits, such as articles from peer-reviewed journals. Ultimately, though, “the onus is on you, the patient, to provide evidence that the treatment is effective,” says Hector De La Torre, executive director of the Transamerica Center for Health Studies, a nonprofit institute for health care education. Resources include the National Center for Complementary and Integrative Health, PubMed and MedlinePlus.
Set Up a Tax-Exempt Account
Two types of savings accounts can be used for health care expenses, including certain CAM therapies, such as acupuncture. Flexible Spending Accounts, offered by some employers, and Health Savings Accounts, available to people with high-deductible health plans, set aside pre-tax dollars to be used for certain health costs. Check with your account provider to find out if your CAM therapy is considered a qualified medical expense.
Bargain with Your Provider
If your insurance company refuses to pay for your CAM treatments, see if the treatment provider will cut you a deal. If you know you’ll be receiving several treatments, you might be able to negotiate a lower rate (especially if you pay up front).
AUTHOR: ALYSSA SHAFFER