An Army report recommended the use of alternatives to pain drugs, including chiropractic care, massage and acupuncture. Here, Dr. Frank Lawler gives Spc. David Ash chiropractic treatment, January 7, 2011, in Tacoma, Washington. Under the Affordable Care Act, alternative and complementary medicine could make more headway into the mainstream health care system because insurance companies can no longer discriminate against a licensed provider. (Mark Harrison/Seattle Times/MCT)
Complementary and alternative medicine — a term that encompasses meditation, acupuncture, chiropractic care and homeopathic treatment, among other things — has become increasingly popular. About four in 10 adults — and one in nine children — in the U.S. are using some form of alternative medicine, according to the National Institutes of Health.
And with the Affordable Care Act, the field could make even more headway in the mainstream health care system. That is, unless the fine print — in state legislation and insurance plans — falls short because of unclear wording and insufficient oversight.
One clause of the health law in particular — Section 2706 — is widely discussed among providers of alternative medicine because it requires that insurance companies “shall not discriminate” against any health provider with a state-recognized license.
That means a licensed chiropractor treating a patient for back pain, for instance, must be reimbursed the same as a medical doctor. In addition, nods to alternative medicine are threaded through other parts of the law in sections on wellness, prevention and research.
But because under the health care law each state defines its essential benefits plan — what is covered by insurance — somewhat differently, the wording concerning alternative medicine has to be very specific in terms of who gets paid and for what kinds of treatment, said Deborah Senn, the former insurance commissioner in Washington and an advocate for coverage of alternative medicine.
For example, naturopathic care would not fall under the nondiscriminatory list in Missouri because the state does not recognize it as a licensed practice.
And even if a practice is licensed, that doesn’t mean it will receive coverage, said Afua Bromley, a licensed acupuncturist at the Acupuncture St. Louis and Wellness Center.
“Some people have the misconception that the (Affordable Care Act) means that acupuncture coverage will be mandated, and that’s not the case,” she said.
Insurance companies can still decide not to include acupuncture in their plans, so Bromley cannot bill an agency for acupuncture care if coverage isn’t provided.
However, because she’s licensed, Bromley will be able to bill insurance companies for office visits, just like a medical doctor can bill separately for an office visit, nutritional counseling, exams and more.
Also, if an insurance company reimburses an M.D. for practicing acupuncture on a patient, that company is then required to reimburse licensed acupuncturists as well.
For a practice such as chiropractic care, the benefits are a bit more recognizable in Missouri.
Margaret Freihaut, insurance committee chairwoman for the Missouri State Chiropractors Association, said the state already has a law in place where fully insured plans — employers pay premiums to insurance companies — must provide coverage for chiropractic care.
Self-funded companies in which the employer has a separate pool of money to pay for employees’ claims — often state workers — are not required to cover chiropractic care. Many of them do anyway, but they don’t cover as many visits as the law requires.
“But now with this anti-discrimination, unless they’re limiting (everyone), they can’t just limit one profession,” Freihaut said.
This could affect global fees, too. Some insurance companies pay one set fee to chiropractors even if the services amount to more. This, just like Bromley’s acupuncture, differs from the itemized billing at a medical doctor’s office, where many services are billed separately.
“We don’t know how (insurance companies) are going to handle it,” Freihaut said, but “I would assume they can’t keep doing that because they would be paying for the same service at a different fee.”
In the long run, Freihaut and Bromley say including their practices in health care coverage is actually cheaper for insurance agencies, because their care can prevent surgery and expensive drugs.
Proving that alternative medicine has real, measurable benefits has been key to increasing its role in the system, said John Weeks, editor of the Integrator Blog, an online publication for the alternative medicine community. The Patient-Centered Outcomes Research Institute, created by the health law, is funding studies on alternative treatments to determine their effectiveness.
Weeks said both lawmakers and the general public will soon have access to that research, including the amount of money saved by integrating other forms of medicine into the current health system.
Freihaut said she’s excited about what this means for consumers.
“It’s a very positive thing,” she said. “It’s going to level the playing field so that people can make their own health care choices.”
But Bromley said because acupuncture care receives little to no insurance benefits in Missouri, it’s not likely she will be affected by the Affordable Care Act until the state embraces her practice.
“In theory, it’s great,” she said. “In reality, I continue taking my cash patients.”
Ankita Rao of Kaiser Health News contributed to this report.
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