CAMLAW: Complementary and Alternative Medicine Law Blog

Can I Get My Use of CAM Therapies Reimbursed?

Most insurance plans do not offer third-party reimbursement for CAM therapies and those that do tend to offer discounted packages on visits to CAM providers within a network. The number of visits reimbursed is often limited.

Insurance definitely has not caught on to "integrative care." There is no system for ensuring the kind of seamless referrals that you might find, for example, between a primary care doctor and a specialist, or a specialist and a surgeon. The insurance system has a long way to go in recognizing integrative medicine, and helping it move forward. It's a good idea to read your insurance policy very carefully before making any assumptions about reimbursement; contact your carrier if in doubt.

Recognize that insurance policies are invariably murky. For example, they may exclude "experimental treatment:" does that mean acupuncture? Ask, and get the answer from your carrier in writing.

If you suspect any monkey business from your insurer, you can always contact your state's Commissioner of Insurance, who can intervene and make sure you are being treated fairly.

In the old days, courts used to interpret any ambiguities in an insurance contract in favor of the insured, who was presumed to be more vulnerable and less savor than the big corporation. But this rationale is changing, and increasingly, courts recognize the saavy and sophistication of modern, Internet-weaned consumers.

In short, the good news is that "alternative medicine" is catching on among insurance companies, with the caveat that this may simply be a marketing ploy, and it's best to read the fine print carefully, or ask for clarification in writing to be sure you understand unambiguously what is being offered.

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COMPLEMENTARY & ALTERNATIVE MEDICINE LAW BLOG

Michael H. Cohen, Esq.; 468 North Camden Dr. | Beverly Hills, California 90210 | 310-844-3173