Complementary and Alternative Medicine: Part II: Paying for Complementary Health Care

Complementary and Alternative Medicine

Part II: Paying for Complementary Health Care

By Evelyn Cunico, M.A., M.S.

Posted August 18, 2014

If you are considering using complementary and alternative medicine (CAM), such as, acupuncture, herbal supplements, meditation, or other diverse medical and health care practices and products that are not part of conventional medicine, you may have questions about payment.

Americans spent an estimated $33.9 billion out-of-pocket on CAM over the previous 12 months, according to the 2007 National Health Interview Survey (NHIS). The survey showed that CAM accounts for approximately one and one-half percent of total health care expenditures, and more than eleven percent of total out-of-pocket expenditures on health care in the United States.

The NHIS is an annual survey in which thousands of Americans are interviewed about their health-related and illness-related experiences. The 2007 survey included a CAM component. According to data from the 2007 NHIS, approximately 38 percent of adults use some form of CAM for health and wellness or to treat a variety of diseases and conditions.

The CAM component of the NHIS was developed by the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics (NCHS) part of the Centers for Disease Control and Prevention (CDC).

The NCCAM has developed a Fact Sheet, entitled, “Paying for Complementary Health Approaches.” See the Fact Sheet for the following questions and for more information.

 Questions to Ask Your Insurance Provider about Payment

  • Does my health plan cover this complementary approach, for my health condition?
  • Does this complementary approach need to be preauthorized or preapproved?
  • Do I need a referral?
  • Do I have to see a practitioner in your network to be covered?
  • Do I have any coverage if I go out-of-network?
  • Are there any limits and requirements – for example, on the number of visits or the amount you will pay?
  • How much do I have to pay out-of-pocket?

 

Questions to Ask Your Complementary Health Practitioners about Payment

Costs

  • What does the first appointment cost?
  • What do follow-up appointments cost?
  • How many appointments am I likely to need?
  • Are there any additional costs (for example, tests, equipment, supplements)?

Insurance

  • Do you accept my insurance plan?
  • What has been your experience with my plan’s coverage, for people with my condition?
  • Do I file the claims, or do you take care of that?

 

Insurance Coverage for Complementary Health Approaches

The NCCAM cautions that insurance coverage of complementary health approaches is complex and confusing. Coverage may vary greatly, depending on state laws, regulations, and differences among specific insurance plans. If you are considering a complementary approach, and you are wondering whether your health insurance will cover it, asking your health insurance provider questions is a good way to start.

A disclaimer: The information presented in this blog should not replace the medical advice of your doctor. You should not use this information to diagnose or treat any disease without first consulting with your medical doctor or other healthcare provider.

References

 Nahin RL, Barnes PM, Stussman BJ, and Bloom B. “Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007.”  National Health Statistics Reports (number 18). Hyattsville, MD: National Center for Health Statistics. 2009.
(Accessed 15 August 2014)

 National Institutes of Health. National Center for Complementary and Alternative Medicine (NCCAM). “Americans Spent $33.9 Billion Out-of-Pocket on Complementary and Alternative Medicine.”
(Accessed 27 July 2014)

 National Institutes of Health. National Center for Complementary and Alternative Medicine (NCCAM). “NCCAM Clearinghouse.”
(Accessed 17 August 2014)

 National Institutes of Health. National Center for Complementary and Alternative Medicine (NCCAM). “Paying for Complementary Health Approaches.”
(Accessed 28 July 2014)

 National Institutes of Health. National Center for Complementary and Alternative Medicine (NCCAM). “Statistics on Complementary and Alternative Medicine National Health Interview Survey.”
(Accessed 17 August 2014)

 National Institutes of Health. National Center for Complementary and Alternative Medicine (NCCAM). “The Use of Complementary and Alternative Medicine in the United States: Cost Data.”
(Accessed 15 August 2014)