All HMOs rely on primary care doctors to provide or approve most care for their members. They also tend to cover only “medically necessary” and “non-experimental” treatments.
Therefore, HMOs may not be willing to reimburse members for alternative medical treatments, such as acupuncture, biofeedback, massage therapy and chiropractic care.
But such treatments are growing in popularity. More than one-third of all Americans have already tried at least one of them.
Here’s how to get your HMO to pay for alternative approaches…
• Find out if the HMO must pay for the treatment in your state
Find out if the HMO must pay for the treatment in your state, and under what circumstances. Some states now require that health insurers pay for certain treatments especially chiropractic care. Your state’s insurance department can fill you in
• Convince your primary care physician to recommend an alternative treatment
Explain how it will likely succeed in treating your medical problem. Some HMOs will pay for alternative treatments if you get a referral from your HMO doctor. Call the HMO to find out its policy.
• Ask alternative treatment providers if they know of HMOs that cover their care
Ask if they will allow referrals for alternative treatments. There may be limits for example; chiropractic treatment for lower back pain may be covered, while the use of alternative therapies for chronic illness may not be.
• Ask your employer to add alternative therapies to your benefits
Some HMOs offer riders that expand coverage to include nontraditional therapies. It will cost your employer more, so you will probably see somewhat higher premiums as a result. The larger the number of your fellow employees who want such a benefit, the more likely it is your request will be granted.
• If treatment is denied coverage, use tax sheltered money
Many employers offer flexible spending accounts, which permit you to set aside pretax dollars to pay for uncovered medical expenses.
Acupuncture and chiropractic care qualify, since the IRS has ruled that both are tax-deductible medical expenses. The IRS hasn’t ruled on other treatments, so check with your employer. Also find out if you need a medical doctor’s referral before getting your treatment.
Be careful when you set aside money in a flexible spending account. If you don’t use all the money that is set aside by the end of the year, you forfeit the remaining amount.
