Health Care Systems - What happens when there is a need for alternative care?






Chiropractors, massage therapists, naturopaths and acupuncturists used to be considered alternative health care providers. Today these services are no longer thought of as alternatives to mainstream medicine. Instead they are considered complementary services. These services can be used alone or in conjunction with conventional treatments. As alternative medicine is more widely accepted, more health care plans are covering the alternative services for their patients. [ See also Chapter 7: Health Care Careers and Chapter 10: Alternative Medicine for more information on alternative medicine.]

Some alternative clinicians are licensed by states and recognized as providers by health care plans. However, alternative treatments are often covered only for specific conditions. For example, a health care plan may cover acupuncture treatment for chronic pain management for one patient. Another patient who wants to use acupuncture for a knee injury may be denied coverage by the same health plan. If a consumer is interested in alternative care, it is important to find out what kinds of treatments are covered and for what conditions.

There remains a lack of mainstream research about alternative medicine and its effectiveness. As a result, managed care organizations will only cover treatments with clear outcomes and evidence. Some alternative practices may not meet these strict guidelines.

Once again, communication with the primary care physician is critical. A patient who decides to pursue alternative treatment should inform and consult with the primary care physician to ensure coordination of all health services. At the same time, a patient should always inform the alternative provider of treatments and medications prescribed by the physician. A patient will get the most effective care when all providers are working with the same information and for the same purposes.

Chiropractic

Chiropractic is the oldest alternative clinical practice in the United States and the most widely licensed. All fifty states and the District of Columbia license chiropractors.

Chiropractors, or doctors of chiropractic, regularly treat lower back pain, headaches, and problems with the neck, the upper back, and the nervous system through spinal manipulation.

Managed care plans vary in their coverage of chiropractic treatment. Some HMOs have chiropractors as part of the network of providers. If patients think chiropractic treatments would be beneficial, they should review the health plan's materials and call member services for more information.

Acupuncture

Acupuncture is an ancient Asian medical practice that involves using very thin needles to pierce different parts of the body to treat certain conditions or relieve pain. Acupuncturists are licensed in twenty-four states and the District of Columbia.

Managed care plans vary widely in their coverage for acupuncture therapy. Some plans do not cover acupuncture at all. Other plans will cover acupuncture for use as an anesthesia (pain blocker) during surgery. If patients think acupuncture treatments would be beneficial, they should review the health plan's materials and call member services for more information. The patient should be prepared to offer evidence that the acupuncture treatment is medically necessary.

Naturopathy

Doctors of naturopathy, or naturopaths, believe in treating illnesses without the use of medications or surgeries, relying instead on natural elements for healing. Some states license naturopaths, but many naturopaths practice without a license in a physician's office or independently. If the naturopath practices in conjunction with a physician, and the doctor prescribes the treatments, the chances of getting health care reimbursement or coverage are greater.

Managed care plans want to do whatever it takes to keep members healthy. Not only is the practice of alternative medicine spreading, health care plans have started to offer complimentary extras to members that focus on member wellness. For example, most health plans have newsletters that contain information about healthy habits and preventive care, self-care and self-help practices, and member services such as exercise classes, yoga, meditation, nutrition education, help to stop smoking, and weight management. There may also be support groups or classes for people suffering from serious illnesses.

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