1. Health

Why Won't Health Insurers Pay for Alternative Medicine or Complementary Therapy?

By

Updated November 14, 2008

Question: Why Won't Health Insurers Pay for Alternative Medicine or Complementary Therapy?
Many of us participate in therapies ranging from massage or meditation, to taking herbal supplements or vitamins to improve our health. They are all focused on improving our health, yet most health insurers refuse to pay for these alternative or complementary therapies. Why won't they pay for them, and what can we do about that?
Answer:

Like the answers to so many questions about health insurance and coverage, the short answer is, "follow the money."

We know, of course, that health insurers are in business to make money and save money (regardless of whether or not they are considered non-profit.) The more services they can exclude from coverage while still selling policies to patients, the better for their businesses.

If you ask the health insurers themselves why they don't cover complementary or alternative treatments (called CAM by the federal government) they will tell you it's because there is too little evidence to prove most CAM remedies are useful to patients.

This is partially true, but not exactly a complete answer.

It's true that evidence of effectiveness is difficult to come by, depending on the particular treatment or therapy you seek evidence for. The reason, in part, is because there is so little research being done to arrive at those answers. Without the research, the evidence can't be developed.

There is some evidence available for some aspects of complementary and alternative therapies. Most insurance companies prefer not to keep up with that evidence, and won't consider changing their coverage until a patient, group of patients, or practitioners begin putting pressure on them to change. That pressure, of course, forces them to be more customer-focused.

How Can You Get Your Insurance Company to Begin Covering CAM Therapies?

If you have your mind set on a particular form of CAM therapy, contact your insurer to ask about coverage. If they say no, then ask the reason why. If they tell you it's because there is no evidence that it works, then begin looking for the evidence yourself.

If you find scientific evidence that it works, then ask them to change their policy by disputing a denial of claim. This may take making some noise, even working through your employer's human resources department, but you may convince them to change their mind. If they realize it's something more potential customers will be looking for, they may decide to begin coverage.

What if Your Insurance Company Will Not Change its Policy?

Consider changing your insurance to catastrophic or high-deductible coverage. It's much less expensive than insurance with a lower deductible, and that frees up the extra cash you can then spend on those herbal remedies or complementary therapies in which you are interested.

A high deductible / catastrophic insurance plan goes hand in hand with a health savings account. If you set up one of these accounts, you will be able to pay for many of those therapies in before-tax dollars, too.

Or, consider changing health insurers during your next open enrollment period. Look for a new insurer that may provide coverages your current one does not.

Learn Why "Follow the Money" Is the Answer to More Health Insurance Questions:

  1. About.com
  2. Health
  3. Patient Empowerment
  4. Money Matters: Managing Medical Costs and Health Insurance
  5. Follow the Money
  6. Health Insurance Coverage - Why Won't Health Insurance Cover Alternative or Complementary Therapy

©2014 About.com. All rights reserved.

We comply with the HONcode standard
for trustworthy health
information: verify here.