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Paying for CAM Treatment
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- General Questions
- Insurance Issues
- Tax-Related Matters
- Sources of Financial Assistance
- For More Information
If you are using (or thinking about using) complementary and alternative medicine (CAM)A group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine., you may have financial questions about paying for treatment. This fact sheet answers some frequently asked questions on this topic. To find out more about any topic or resource that is mentioned, see For More Information.
How do people pay for CAM treatments?
They pay for CAM treatments in one or both of these ways:
- Out-of-pocket. Most people must pay for CAM services and products themselves.
- Insurance. Not all health insurance plans offer CAM coverage, however. When they do, the coverage varies by state and is often limited. Examples of CAM therapies that are sometimes covered by insurance are chiropractic, acupunctureA family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles though the skin. It is intended to remove blockages in the flow of qi and restore and maintain health., massagePressing, rubbing, and moving muscles and other soft tissues of the body, primarily by using the hands and fingers. The aim is to increase the flow of blood and oxygen to the massaged area. therapy, biofeedbackThe use of electronic devices to help people learn to control body functions that are normally unconscious (such as breathing or heart rate). The intent is to promote relaxation and improve health., and naturopathyA whole medical system that originated in Europe. Naturopathy aims to support the body's ability to heal itself through the use of dietary and lifestyle changes together with CAM therapies such as herbs, massage, and joint manipulation.. Consumers' interest in CAM coverage is prompting more insurance companies and managed care organizations to consider offering this coverage as an option.
What are some questions to ask about paying for CAM treatment?
Some questions to ask a CAM practitioner or his office staff are:
- What does the first appointment cost?
- What do followup appointments cost?
- How many appointments does someone with my condition typically need?
- Are there any additional costs (such as for tests, equipment, or supplements)?
If you have a health insurance plan, some other questions are:
- Do you accept this insurance?
- What has your experience been with coverage by this insurance company for my condition?
- Do I file the claim forms, or do you take care of that?
If it would be difficult for you to pay the full fee at each visit, you can ask:
- Could you arrange a payment plan over time?
- Do you offer a sliding-scale fee? (Sliding-scale fees are determined by people's income and ability to pay.)
What types of CAM coverage do employers offer?
If an employer offers CAM coverage, it usually has one or more of the following aspects:
- Deductibles that may be higher than those for conventional care. A deductible is a total dollar amount that you must pay before the insurer begins making any payment for treatment.
- Policy riders. A rider is an amendment that modifies the policy's coverage in some way (for example, by increasing or decreasing its benefits). You may be able to purchase a rider for CAM coverage.
- A contracted network of providers. Some insurers contract with a group of CAM providers who agree to offer their services at a lower rate to members than to nonmembers. You pay out-of-pocket, but at a discounted rate.
Employers negotiate with insurance companies for their rates and services, usually once a year. The Agency for Healthcare Research and Quality, part of the Federal Government, has publications on choosing and using a health insurance plan.
What are some important things to find out about my plan's coverage of CAM?
First, it is important to read your plan to find out whether it discusses coverage of the therapy in which you are interested. If anything about the coverage is not clear or you have questions, contact the insurance company before you decide about having treatment. Examples of questions that people often ask company representatives are:
- Is this treatment covered for my health condition?
- Does this care need to be:
- Preauthorized or preapproved?
- Ordered by a prescription?
- Ordered through a referral from my primary care provider?
- Do I have to see a practitioner in your network in order to be covered?
- Do I have any coverage if I go out-of-network?
- Are there any limits and requirements—for example, on the number of visits or the amount you will pay?
- What do I have to pay out-of-pocket?
It is a good idea to keep detailed records about all contacts you have with the insurance company, including notes on calls and copies of bills, claims, and letters. This will help you if a dispute arises about a claim.
Does my state have any laws about CAM coverage?
The following resources can help you answer this question:
- Each state and U.S. territory, as well as the District of Columbia, has a department of insurance (check the government pages, or blue pages, of your phone book). This department regulates the insurance industry within its region, enforces pertinent laws, and assists consumers. The services vary, but every office responds to consumer inquiries on insurance.
- If you are seeking CAM treatment from a practitioner, there is likely to be at least one professional association for the specialty—for example, associations for chiropractors. Many of these associations monitor insurance coverage and reimbursement in their field. You can search for them on the Internet or ask a reference librarian for help.
Which insurance companies cover CAM?
Your state insurance department may be able to help you with this question. Many of these departments provide consumer publications, such as profiles and ratings of companies. (They do not provide recommendations or advice on specific companies.) An insurance broker (an agent who sells policies for a variety of companies) may also be a resource.
My insurance company denied my claim for CAM treatment. Is there anything I can do?
Yes, there are some things you can do:
- Know your plan, including what it does, and does not, cover.
- Check whether the CAM practitioner's office or your insurance company has made a coding error.¹ To do this, compare the codes on the practitioner's bill with the codes on the document you received from the insurance company.
- If you think your insurer may have made a mistake processing your claim, you can request a review.
- The insurance company should also have a process for appealing coverage decisions.
- You can ask the CAM practitioner if there is anything she can do, such as writing a letter on your behalf.
If the problem is still not resolved, contact your state insurance department.
What are FSAs and HSAs, and can they help me with CAM expenses?
An FSA (short for flexible spending arrangement or flexible spending account) is a benefit offered by some employers. An FSA allows you to set aside pretax dollars each pay period for health-related expenses (some employers also make contributions). You submit receipts for yourself, your spouse, and/or your dependents to the FSA administrator for health-related expenses that were not covered some other way (for example, by insurance). You are then reimbursed for qualifying expenses (check your plan's language on this), such as deductibles, medical appointments, tests, and medicines.
An HSA (short for health savings account) is another type of tax-exempt account. It is for people who participate in a high-deductible health plan (also called a catastrophic health plan). In an HSA, you—not your employer—establish and maintain the account (although some employers make contributions). You can also invest your HSA funds to earn tax-deductible interest.
The Internal Revenue Service (IRS) has further information on these accounts. The IRS does not allow the same expenses to be reimbursed through an FSA or HSA and also claimed as tax deductions.
Can I deduct CAM treatments on my income tax return?
In tax year 2007, the IRS allowed taxpayers to deduct medical expenses for a limited number of CAM services and products, such as acupuncture and chiropractic care. These expenses were generally allowed for taxpayers and their spouses and dependents. Note that people cannot deduct the same medical expenses from their taxes and an FSA or HSA.
Sources of Financial Assistance
Can the Federal Government help me with expenses for CAM?
The Federal Government helps with at least some of the health expenses of people who are eligible for Federal health benefit programs—usually because they meet one or more of the following conditions:
- They have a low income and limited resources.
- They do not have other medical insurance.
- They have a disability or certain medical conditions.
- They are part of a population that has difficulty obtaining medical care.
- They are at least 65 years old.
- They have served in the military.
That assistance may be direct (through payments) or indirect (through benefits like medical care at public clinics). Examples of programs that may provide some CAM coverage under some circumstances (as of July 2008) are:
- The Department of Veterans Affairs (for chiropractic care and acupuncture).
- Medicare, which covers chiropractic but does not cover what it calls "alternative therapies," giving as examples acupuncture, chelation therapyA practice in which a chemical is used to bind with and remove excess metals and minerals, such as lead or calcium, from the body., biofeedback, and holistic medicine.
- Medicaid, depending on your state's guidelines.
GovBenefits and USA.gov are two Internet resources that explain Federal health benefit programs. GovBenefits has a test you can take about qualifying for programs. State and local departments of health or social services also have financial assistance programs for eligible residents, and you can contact them directly to inquire.
Does NCCAM provide financial help for CAM treatment?
Financial help for treatment does not fit under NCCAM's mission. NCCAM does sponsor clinical trials (research studies in people) of some CAM treatments. To find out what therapies are being studied and whether you might qualify to participate, go to nccam.nih.gov/clinicaltrials/, or contact the NCCAM Clearinghouse.
Are there any other potential sources of financial assistance?
If treatment (whether CAM or conventional) for a disease or condition is creating a financial crisis for you and your family, you might find it helpful to contact nonprofit organizations that focus on the disease or condition. To locate them, try an Internet search or check directories at your local library. If you are receiving care at a hospital or clinic, ask if a social worker or patient advocate could advise you.
For More Information
The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
Toll-free in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: nccam.nih.gov
A service of the National Library of Medicine (NLM), PubMed contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. CAM on PubMed, developed jointly by NCCAM and NLM, is a subset of the PubMed system and focuses on the topic of CAM.
Centers for Medicare & Medicaid Services (CMS)
CMS administers several programs: Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP).
Toll-free in the U.S.: 1-877-267-2323
TTY (for deaf and hard-of-hearing callers): 1-866-226-1819
Web site: www.cms.hhs.gov
- Medicare: my.medicare.gov or call 1-800-633-4227
- Medicaid: www.cms.hhs.gov/home/medicaid.asp
- SCHIP: www.cms.hhs.gov/lowcosthealthinsfamchild
Department of Labor (DOL)
DOL has publications on Federal health care laws, including HIPAA and COBRA, that apply to job seekers, workers, and retirees.
Toll-free in the U.S.: 1-866-4-USA-DOL (1-866-487-2365)
TTY (for deaf and hard-of-hearing callers): 1-877-889-5627
Web site: www.dol.gov
- Consumer health plans and benefits information: www.dol.gov/dol/topic/health-plans/index.htm
Internal Revenue Service (IRS)
The IRS is the nation's tax collection agency. Among its services are publications for consumers.
Toll-free in the U.S.: 1-800-829-1040
TTY (for deaf and hard-of-hearing callers): 1-800-829-4059
Web site: www.irs.gov
- Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans: www.irs.gov/pub/irs-pdf/p969.pdf (PDF)
- Publication 502, Medical and Dental Expenses: www.irs.gov/pub/irs-pdf/p502.pdf (PDF)
This publication is not copyrighted and is in the public domain. Duplication is encouraged.
NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCAM.
NCCAM Publication No. D331
Created November 2006
Updated August 2008
Note: The PDF file requires a viewer such as Adobe Reader, which you can download free of charge from the Adobe Web site.