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Paying for Complementary and Alternative Medicines

Health_1210b_ImageComplementary and alternative medicine (CAM) is a term used to describe medical and health care practices and products that are not generally considered to be part of conventional medicine. Complementary medicines are used in conjunction with -- and alternative medicines are used in place of -- conventional medicine. The 2007 National Health Interview Survey indicated that 38 percent of adults use CAM.

What falls under the definition of CAM?

The lines between CAM and conventional medicine are not always clear, but among types of CAM are:

  • Natural Products: dietary supplements, herbal medicines (botanicals), live microorganisms (usually bacteria), probiotics...
  • Mind-Body Medicine: meditation, yoga, acupuncture, deep-breathing exercises, guided imagery, hypnotherapy, progressive relaxation, tai chi...
  • Manipulative and Body-Based Practices: spinal manipulation and massage performed by chiropractors, physical therapists, osteopaths...

(Source: National Center for Complementary and Alternative Medicine)

Do health insurers pay for CAM services?

People usually pay for CAM services and products themselves, even if they have health insurance. According to the 2007 National Health Interview Survey, adults in the United States spent an estimated $33.9 billion out-of-pocket on CAM treatments during the previous 12 months. Of that, $22 billion was spent on self-care costs (products, classes, and materials), and the rest on visits to CAM practitioners. Out-of-pocket expenditures on CAM treatments accounted for approximately 1.5 percent of total health care expenditures and 11.2 percent of the total out-of-pocket health care expenditures.

CAM therapies like chiropractic and acupuncture may be covered on some health policies, but coverage of most CAM therapies has been very limited when compared to conventional therapies. When using a CAM service, it is important to inquire about payment options and to check with your insurer in advance.

Some CAM expenses may be tax deductible. In tax year 2009, the IRS allowed taxpayers to deduct medical expenses for acupuncture, chiropractic care, and osteopathic care.

Source: National Institutes of Health

CAM and The Affordable Care Act

Things are looking up. The Natural Products Association (NPA) is the nation's largest and oldest nonprofit organization dedicated to the natural products industry. Executive Director and CEO John Cay:

"The Natural Products Association believes it is important to protect an individual's health freedoms by supporting access to the type of health care they want. Interest in alternative or complementary health care is increasing, both among the public and many health professionals. NPA believes in freedom of choice in health care for both consumers and providers because alternative or complementary approaches are often more preventive and cost effective.

Prevention also is a big part of health care reform. Currently, there is still much discussion among Congressional leaders and the Obama administration on how parts of the Affordable Care Act will be implemented. The recent changes to Congress following the election may have an impact on that as well. NPA will be reaching out to the newly-elected members of Congress and their staffs to begin educating them about the natural products industry. The more these new Representatives and Senators hear from their constituents, the better. NPA also keeps members informed about any changes to health care regulations that might affect them."

The American Chiropractic Association (ACA), released a press release earlier this year that said, in part:

"Regardless of how you feel about this legislation and its overall impact on the nation, it has to be recognized as an historic first for the chiropractic profession. We now have a federal law applicable to ERISA (Employee Retirement Income Security Act) plans that makes it against the law for insurance companies to discriminate against doctors of chiropractic and other providers relative to their participation and coverage in health plans.
The language in the bill ensures that doctors of chiropractic can be included in these patient-centered, holistic teams. ACA President Dr. Rick McMichael noted, "This language was a critical inclusion to give doctors of chiropractic increased opportunities to be fully engaged as part of the health care team."

From an American Herbal Products Association (AHPA) press release:

"Among the provisions included in the final law, section 4206 would have a direct effect on those dietary supplements for which there are FDA-approved health claims by setting up a pilot program for "wellness plans," which can now include those few supplements with "health claims approved by the Secretary." Currently approved health claims include, for example, claims for calcium and osteoporosis; soluble fiber and coronary heart disease; and folic acid and neural tube birth defects.

Other sections of the new law will also promote more inclusion for CAM practitioners. These include section 5101, that establishes a National Healthcare Workforce Commission to work with the U.S. Department of Health and Human Services; and section 3502, which creates "community health teams," defined to include, among others, "licensed complementary and alternative medicine practitioners."

"The new health care law is a starting point for a broader inclusion of CAM within the U.S. healthcare system," said AHPA President Michael McGuffin. "If managed properly, greater inclusion of alternative practitioners in health care should open a pathway for increased acceptance of the dietary supplement products they provide."

Use of complementary and alternative services and products is growing, as is belief in a mind/body connection in prevention and healing of illness. Health insurers - and the law - appear to be a work in progress.

Ann Pietrangelo is a freelance writer covering a wide range of issues, most notably multiple sclerosis patient advocacy, health care policy, and healthy living.

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