What to do before your first office visit
The first step toward getting good health care is educating yourself, and the second is — finding it! Then the hard work begins: finding a way to pay for it. After you read the text of your insurance policy, pore over the fine print. Arm yourself with information about your coverage before you enter the doctor’s office. Here are some specific things you can do to keep some of the "out- of-pocket" in your pocket.
When making your first appointment
Find out what non-traditional (alternative) modalities are offered through your primary health-care provider’s office. It is likely that your doctor has chosen to use these modalities to augment his/her allopathic offerings and prescribes them in his/her course of treatment. These "alternative" treatments will always be under scrutiny by your insurance company.
Find out who the provider is for each modality. What is his/her licensure in this state? Does the practitioner have to be an M.D. or can a board-certified (acupuncturist) administer the treatment with a doctor’s referral? Keep in mind that many modalities do not have state licensure. In the state of Illinois for example, a massage therapist can neither diagnose or gain insurance reimbursement unless the treatment is prescribed by an M.D., (Medical Doctor) D.O. (Doctor of Osteopathy), or D.C. (Doctor of Chiropractic). Some insurance companies demand that the doctor be on the premises at the time of the treatment. Most alternative therapies, however, must be prescribed and administered under the supervision of a physician. A few treatment approaches will be under question no matter who performs them.
Call your insurance company
Ask your insurance provider if there are diagnostic restrictions for any of the modalities offered at your doctor’s office. For instance, they may cover acupuncture for low back pain but not for headaches. Some therapies will never be covered if they are described under their popular name. Bodywork specialties are often named after their originator (e.g., Rolfing, Trager, Feldenkrais). Most insurance companies won’t cover them, per se, but they will cover "myofascial release or massage." Use these general terms when talking to the insurance company.
Ask about the frequency limitation within a calendar year. When, within the course of treatment, must a condition be re-evaluated after a series of sessions for the coverage to continue?
Get the name of the insurance company representative. It may be your only defense if the claim is later denied. Remember, claims are often handled by different individuals at different submissions times, so the decision to pay on a course of treatment may not be consistent.
Talk to your doctor!
The hard-working receptionist is not the person that determines the type of care and length of treatment for a patient. So tell the doctor what you know about your coverage when you discuss your treatment plan. The degree and frequency of visits and order in which you receive certain modalities may be adjusted to maximize the care you receive for the coverage you have.
The Sad Truth
Sometimes you will just have to pay for alternative treatments out of your own pocket. But remember that many of us have been paying for these "wacky, un-proven," highly effective modalities for years. Our demand for and self-payment for these treatments is what turned the heads of the corporate disease-care system in the first place. So think of it as an investment in the future of health care. Your dollars won’t go unnoticed.