Gotcha Covered!: Insurance Companies Embrace Alternative Therapies
By Catherine Monahan

When Californians embrace unusual ideas, it's a toss-up what it means to the rest of the country. But when it comes to medicine, their penchant for alternative care crosses state lines. Today, normally staid insurance titans Aetna U.S. Healthcare, Cigna HealthCare and BlueCross/BlueShield are casting their lots with complementary medicine. The question no longer is who will be first, but how far will they go?

Meeting Consumer Demand
During the HMO heydays in the late '80s, experts predicted that nothing less than a total lockdown could control skyrocketing medical costs. Managed care flourished, but not necessarily patient satisfaction. Americans discovered complementary medicine. And they liked it.

David Eisenberg's widely quoted survey, published in the New England Journal of Medicine (1993, vol. 328), suggests that one in three Americans tried alternative care in 1990 and spent $10.3 billion of their own money for the experience. His follow-up survey, published in the Journal of the American Medical Association (1998, vol. 280) found that the numbers only increased—visits to alternative medicine practitioners spiked more than 47 percent from 1990 to 1997, and people shelled out $12.2 billion to cover it.

Insurance companies noticed.

"Many insurance companies around the country have been looking at alternative medicine because of consumer demand," says Rick Gallion, director of complementary and alternative medicine for BlueCross/BlueShield of South Carolina, based in Columbia.

"Consumers wanted more than what was provided in their core benefits," agrees Scott Richardson, department head for Cigna HealthCare's national amenities program in Bloomfield, Conn. "And employers really had no means of offering access to services or products that fell outside the scope of a traditional benefit plan."

What began as an interesting trend is now what industry watchers call a market readjustment. It's a welcome change for consumers. They're finally getting what they want. "The economy is improving, and employers, who are the major purchasers of health care, are more willing to foot the bill for expanded services," says Mohit Ghose, spokesperson for the Washington, D.C.-based American Association of Health Plans, which represents 1,000 managed-care companies. "A health plan can include whatever you want it to, and employers have moved to a more consumer-friendly position."

"Consumer-friendly" means choice—in most cases the choice to select your own health care practitioner and to make an appointment without first asking permission. Health plans are delivering both. But for some employers, it isn't enough. That's because their employees, many of whom factored in the Eisenberg surveys, are clamoring for more—be it acupuncture, nutrition counseling or massage therapy. Eager to keep members happy and attract new customers, insurance companies are jostling with one another to incorporate alternative therapies in their plans.

"Many insurance companies are looking for ways to differentiate themselves in the marketplace," says Gallion. "To be seen as an innovative company, interested in other alternatives to health care treatment, is a very good way."

Baby Steps
The majority of large insurance companies endorsing complementary care are doing so cautiously—with discount programs. Nearly identical in design, such programs generally offer 25 percent savings on complementary medical services and products such as herbal supplements and vitamins.

Aetna U.S. Healthcare's discount program, launched nationally in 1998 for its 19 million members, offers discounts of up to 30 percent for chiropractic care, acupuncture, massage therapy and nutritional counseling through a network of 7,000 providers, says Michael Eve, general manager for Aetna Colorado. Aetna, headquartered in Hartford, Conn., is the nation's largest insurer.

Other insurers, including Cigna HealthCare, BlueCross/BlueShield of South Carolina, Trigon BlueCross/ BlueShield of Virginia and Kaiser Permanente of Ohio, are turning to specialty provider networks such as American Specialty Health Plans in San Diego to administer their discount programs. "It's an easier first step than a benefit program," says George DeVries, American Specialty's president and CEO. "Discount programs are easier to implement—from an administrative standpoint, the logistics are simpler. Benefit plans are more complex and involve regulatory approvals, member eligibility, sales, customer service and clinical management."

If response to discount programs is positive, and indicators point in that direction, insurers will likely take the next step and offer complementary medical services as optional riders. "We've seen that it is really a true progression," says DeVries. It means acupuncture coverage may soon be sold much like dental or vision care is, as an additional insured product your employer purchases.

"Our groups pretty much dictate to us what they want," adds Judith Mabra, product development manager for Kaiser Permanente of Ohio, based in Cleveland. "I would venture to say that it will be employers who will let us know whether or not they want this as a rider."

It's already happening. Independent of state mandates, California's 10 largest insurers are offering chiropractic service riders, and several are also now covering acupuncture. And, health plans in Hawaii, Florida, Maryland, New York and Rhode Island are currently offering insurance riders for services ranging from chiropractic care to massage therapy.

Whether visits to complementary care providers will be fully covered as core benefits, much like visits to a dermatologist or an obstetrician, is unclear. Like most policy changes, it depends on the market. "If we cover a treatment such as acupuncture as a supplemental rider and give groups the option of purchasing it, then we'll have a good feel for what consumer demand is," says Terri Leonard, product manager of Trigon BlueCross/ BlueShield of Virginia in Richmond. "There's some good information coming from the West Coast that hasn't filtered all the way east yet."

The decision also relies on proof that complementary treatments actually work. "It's very important that physicians buy into these therapies," says Gallion. "They will never be covered by insurance companies unless physicians actually see them as valuable and, for example, refer patients for chiropractic care, massage therapy or acupuncture."

"The discount program is just a first step," he adds. "Once there's scientific evidence behind the claims being made, why wouldn't insurance companies adopt these services as covered benefits?"

Slow But Sure
Health care is a conservative business, and any substantial change is best measured in decades, not years. Complementary medicine's move from California-quirk to near-national acceptance is startling, considering what's involved—consumer interest, media coverage, employer response, safety studies, clinical trials and, not least of all, the 1998 establishment of the National Institutes of Health National Center for Complementary and Alternative Medicine.

"Ten years ago, many of these things weren't in place," says DeVries. Neither were licensing statutes for alternative care providers or the providers themselves. "When you line them all up, the barriers are coming down, and the reassurances and incentives to offer complementary care are going up."

"We're on the verge of something," says Gallion. "We're on the cutting-edge of a new culture of health care in which consumers are going to be making more choices."

Congratulate yourself. It's not every decade that consumers can chalk up such great success.

Catherine Monahan is a health and science writer and a frequent contributor to Delicious Living.