Providing the Alternative
Lifestyle Advantage, a subsidiary company of Highmark Blue
Cross Blue Shield, believes so much in one alternative/complementary medical
model -- Dr. Dean Ornish's Program for Reversing Heart Disease -- that it
completely pays for its costs. For 10 hours a week patients take part in such
activities as moderate aerobic and strength training, yoga, meditation, guided
imagery, and visualization, in addition to following a low-fat diet with
additional supplements such as fish oil and soy.
"I call this the trifecta," says Silberman. "A
program such as this benefits patients, health plans, and providers. I've never
come across an intervention that benefits all three entities."
Because of the success of the Ornish program, Highmark is now
beginning an Osteoporosis Prevention and Education program, and before the end
of the year, Dr. Ornish's prostate cancer prevention program.
BCBSSC, BCBSNC, and Highmark BCBS are just three of the
carriers nationwide who have been promoting CAM therapies to their patients.
There are certainly more, but according to Eric Wurzel, not enough. Wurzel, a
partner in Travers, O'Keefe, a New-York based insurance and employee
benefits-based brokerage firm, says that coverage for complementary and
alternative medical treatments hasn't grown to the extent that it should.
"Eastern medicine has been around longer than western medicine," he
Coverage also varies widely from state to state, says Wurzel.
New York, for example, is "at least 30 years behind California," he
says, adding that benefits for alternative therapies get substantially better
the farther south you move. "Costs are prohibitive in New York," he
explains. "Anything you add on to a policy here will get used by a large
number of people, and those costs aren't cheap."
"Insurance companies are not altruistic organizations,"
says Wurzel. "They're profit centers."
Still, things are changing, if for no other reason than
consumers are demanding it. "We're now seeing consumer-driven
healthcare," says Ken Linde, president and CEO of Destiny Health, an
insurance carrier headquartered in Oakbrook, Ill., that also offers discounted
rates on CAM therapies. "Consumers want to be in charge of their own
If you are interested in seeking complementary or alternative
therapies, do your homework first, says Rhonda Allenson, vice president of case
management services for Managed Care Resolutions, a New York-based consumer
advocate company that assists patients with healthcare disputes.
Read your coverage booklet, says Allenson. Before you receive
services, make sure the treatment you're investigating is covered, and make
sure the provider is covered as well.
If they are covered, find out whether you need
preauthorization. If so, get the authorization number and "document
everything," says Allenson.
"Be proactive," she says. "Don't assume that things
are taken care of on the other end."