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Providing the Alternative

Complementary Coverage?

continued...

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 says.

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 destiny."

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."

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