Coverage of Complementary Benefits Pains Local Doctors

Mental health isn’t the only area that is on the cusp of insurance coverage. Complementary and alternative medicine health benefits like chiropractic exams and acupuncture are others that sometimes are not offered to employees or have caps on the number or dollar amount of treatments.

According to a 1999 study (the most recent report available) published in the American Journal of Public Health, back pain cost U.S. businesses $14 billion a year in lost workdays, based on 1995 figures.

Cindy Beemer, a chiropractor and owner of Beemer Back Center in Springdale, said getting chiropractic benefits is a lot more difficult than it used to be.

“I do see more caps on [patients’] coverage either on their visits or their dollar amounts than we used to,” Beemer said.

When she started in the business in 1984, she said it was usually a $100 deductible, an 80/20 plan (80 percent covered by insurance and 20 percent patients’ responsibility) and no cap on the number of visits.

But sometimes patients aren’t even covered for chiropractic exams under their insurance plan. That’s where American Specialty Health comes in.

ASH is a specialty health care company in the area of employee benefits, said George DeVries, president and CEO of the San Francisco-based company. They are making their way into the Arkansas market, but currently contract with 90 different health plans across the U.S. and cover 1,800 employer groups. They have 12.8 million members under different programs nationwide, making it one of the largest specialty benefits company in the nation, DeVries said.

The American Journal of Public Health study says back pain affects about 17 percent of the U.S. workers at some time during the year. And because of that, 149 million workdays are lost in each year.

“If someone has back pain, they may not be able to work,” DeVries said. “And back pain is one of the leading causes of missed work.”

But not only can those benefits keep employees healthy, they can also lead to decreased medical costs.

A 2004 study published in the Archives of Internal Medicine showed that total annual healthcare cost for employees who had chiropractic benefits were $1,463 per employee compared to $1,671 for those who didn’t have the benefit.

On Pins and Needles

Acupuncture is another complementary benefit that is becoming more popular among health insurance programs, said Tracy Atha, a chiropractor and acupuncturist in Fort Smith.

A traditional Chinese medicine, acupuncture is a method of healing by penetrating the skin with thin, solid, metallic needles using a combination of procedures that involve stimulation of anatomical points in the body.

Atha, who owns The Healing Point in Fort Smith, said the Journal of the American Medical Association published a positive article on acupuncture in 1997. It also said that people were spending just as much out of pocket for alternative medicines with or without insurance coverage. Ever since then, she’s noticed more insurance companies covering acupuncture.

Since 2000, Atha said she’s seen insurance companies change their coverage dramatically.

“Insurance companies have different [insurance plans] that employers choose from, and employers are choosing lesser plans with lesser coverage,” she said.

But still, there are insurance benefits that do cover about 50 percent to 80 percent of a patient’s bill. She said caps are usually on dollar amount spent, not the number of visits. Atha said it usually takes six to 12 treatments for patients to start feeling better.

An acupuncture treatment at Atha’s office costs $45. Having chiropractic adjustment, herbs and other services will cost extra, she said.

The U.S. Food and Drug Administration said people in the U.S. spend about $500 million on acupuncture treatments annually. And according to the 2002 National Interview Survey, about 8.2 million U.S. adults had acupuncture treatments.

The treatment is becoming so commonly accepted that hospitals are taking notice. In 2003, Atha joined the advisory board at The Women’s Center at Sparks, part of the Sparks Health System in Fort Smith.

Lower back pain is one of the most commonly treated ailments with acupuncture, and there is only one thing she’s found acupuncture won’t help and that’s ringing in the ears. Other than that, there really isn’t anything acupuncture doesn’t treat, Atha said. She’s treated everything from back pain to colds to hormonal imbalances.

She said one thing about acupuncture that helps insurance coverage is there is no risk involved in the treatment.

“There’s no known side effects [with acupuncture],” Atha said. “The worst thing that could happen is nothing.”

Alternative Benefits

According to the National Institutes of Health’s National Center for Complementary and Alternative Medicine, if complementary or alternative medicine (CAM) is covered by insurance offered through employers, it will usually consist of one of the following: higher deductibles, policy amendments or a contracted network of providers.

Atha said employers might not elect to have certain benefits, like CAM, because of the higher cost of the plans.

“The richer the plan, the more expensive it is,” DeVries said.

DeVries said total expenditure on complementary healthcare services is $40 billion annually, and about 40 percent of Americans have those benefits.

He said one of many reasons employers choose to offer complementary or alternative medicines is because employees are demanding it, and companies want to find more ways to retain their employees.

When a physician prescribes employees painkillers for certain pains, it could hinder their work, Beemer said. If the employee has the option of going to a chiropractor or acupuncture, then medication doesn’t have to be involved. Atha said sometimes acupuncture can be adversely effected by pain medication.

“The same solution doesn’t work for every person necessarily,” DeVries said. “For back pain, a physician might be able to fix it, but some might need more — like chiropractic or acupuncture. Health care is personal so having a choice is important. Usually, choice in mostly anything is a good thing. I think choice in health care is a good thing.”