California Blue adds an alternative spin
California Blue adds an alternative spin
As increasing evidence that insurers are heeding consumer pleas for coverage of alternative medicine, San Francisco-based Blue Shield recently announced its inclusion of acupuncture as a partially covered service in its HMOs and PPOs, starting with 1998 contracts. Unlike last year’s foray into alternative health care by Oxford Health Plans, in which the Norwalk, CT-based health plan required employers to pay extra premium dollars if they wanted to add coverage for alternative health care, the Blue Shield plan makes alternative care part of its standard package.
The carrier cited increased demand from consumers as the reason behind its coverage of alternative care.
The move comes when national studies are validating alternative medicine. In November of 1997, the prestigious National Institutes of Health (NIH) issued a position statement concluding that needle acupuncture treatment is effective for postoperative and chemotherapy nausea and vomiting, nausea of pregnancy, and postoperative dental pain. And, says NIH, it holds significant promise for other pain relief.
You can expect coverage for alternative medicine to become more common, particularly if you are in a mature managed care market, says Alan M. Kittner, president and chief executive officer of Consensus Health Corporation (CHC). CHC is a San Francisco-based network that is promoting its panel of credentialed alternative medicine providers to insurers across the country, much like other specialist networks are working their way into managed care markets.
Based on a survey Kittner’s organization conducted of HMOs and PPOs in 13 states with developed managed care markets, 58% of HMO and PPO officials reported they plan to offer acupuncture and other alternative medicine treatments in their plans.
Acupuncture is a family of procedures, the most well-known of which involves penetration of specific anatomic locations on the skin, called acupuncture points, by thin, solid, generally metallic needles, explains David J. Ramsay, DM, Dphil. Ramsay is president of the University of Maryland in Baltimore, and chairman of the NIH panel that recently voiced its clinical support of the ancient Chinese procedure.
Acupuncture is one of the oldest and most commonly used forms of traditional medicine in many parts of the world, dating back for at least 2,500 years, Ramsay says. The general theory which undergirds is based on the premise that there are patterns of energy flow called Qi (pronounced "chee") throughout the body that are essential for optimal health. Closely related to and often practiced with acupuncture is moxibustion, the local and focused application of heat to acupuncture points using a compressed, powered combustible substance (moxa), which is burned at or near points to be stimulated.
Public awareness and use of acupuncture increased in the United States following President Nixon’s visit to China in 1972. Nixon attracted international headlines when he underwent acupuncture treatments to ease post-surgery pain.
A 12-member NIH consensus panel also concluded in its study of acupuncture that there are other pain-related conditions for which acupuncture may be effective as an adjunct therapy, or as an acceptable alternative, or as part of a comprehensive treatment program. These conditions include, but are not limited to, addiction, stroke, rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia (general muscle pain), low back pain, carpal tunnel syndrome, and asthma.
This is what the Blue Shield of California is now offering to its PPO and HMO enrollees:
• acupuncture services, including a 25% discount for specific services in the domain of acupuncture such as acupressure, electro-acupuncture, and cupping, as long as they are provided by a licensed acupuncturist in the Blue Shield network;
• chiropractic services provided at a 25% discount off retail charges;
• massage therapy provided by certified massage therapists and somatic educators in the Blue Shield network, including a 25% discount for structural and deep tissue manipulation and massage therapy;
• stress management through self-healing courses using guided imagery offered by a Blue Shield practitioner at a 25% discount;
• discounted fitness packages for Blue Shield members at fitness centers and athletic clubs, including personal trainers.
Following are names and telephone numbers of sources quoted in this issue:
• ProSTAT Resource Group, Overland Park, KS; Philip Beard, principal. Telephone: (913) 663-5588.
• Alta Bates Medical Group, Berkeley, CA; Lori Hack, executive director. Telephone: (510) 597-3006.
• Neil Baum, MD, private practice physician, New Orleans. Telephone: (504) 891-8454.
• Monarch Health Care, Mission Viejo, CA; James Selevan, MD, senior vice president and chief information officer. Telephone: (714) 859-6262.
• Comprehensive Breast Health of New York, New York City; Saul Kaplan, MD, co-director. Telephone: (212) 861-3101.
• Southwest Asthma & Allergy, Missouri City, TX; John White, administrator. Telephone: (281) 499-9505.
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