Alternative Medicine/Managed Care

[Guest Linda P]

I recently heard a talk by the founder of a company that is trying to get alternative medicine into the managed care system. It seems to me that credentialing of providers is a big issue. Anyone with experience as to employer health plans covering alternative medicine.

[Guest ERead]

The last employer that I worked for had similar provisions. The doctors were covered at the regular rate as long as they were listed with the insurance companies. I guess the insurance groups have some type of requirements before listing. Otherwise the prescriptions were covered as well, as long as they were written by the approved physician/doctor/wholistic healer...... what ever.

[Guest nac]

Our plan will cover an alternative provider if . . . s/he is 1) licensed by the state in which s/he practices, and 2) is recognized as a "practitioner of the healing arts" in the state in which s/he practices. This varies from state to state, for example, acupuncturists are recognized as practitioners of the healing arts in our state but not in a neighboring state.

[Guest kchristy]

Here in California, there are several networks that contract with various alternative care providers (such as chiro, acupunture, herbal medicine, massage therapy, et al), and the structure of the plan varies from fully insured, copay-only coverage to discounted fee-for-service.

If I were self-insured and was contemplating adding alternative care coverage to my plan, I would rent a network wherever available, and I would avoid as much as possible taking on risk for employees' visits to these providers. Alternative care, whatever its potential benefits, is largely unmanageable except through benefit maximums such as limits on the number of visits or a global dollar max.

[Guest robkt]

I include "alternative medicine" as a benefit on all self-insured plans. A.M. is defined as "acupuncture". Massage therapy was removed as many chiropractors were providing this service as "physical therapy". This schedule of benefits is available to active as well as retiree participants sponsored by the employer.