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Insurers resist as patients choose 'alternatives'

Advocates of so-called "alternative" and complementary medicine say the practices reduce the overall cost of health care, but some in the insurance industry are not entirely buying it.

Non-Western health care methods have increasingly gained favor among patients who have had little success with traditional health care. Some people also turn to alternatives as a means to prevent minor health problems from becoming chronic.

The mainstream health care industry has begun accepting herbal or homeopathic remedies and practices like massage therapy, acu-puncture and even aromatherapy.

That combination of consumer acceptance and claims that alternative and complementary medicine is ultimately cheaper has yet to translate to full-fledged health insurance coverage. The one exception is insurance coverage of chiropractic care.

Larry Rambo, chief executive officer for Humana Inc.'s Wisconsin market, said Humana does not cover most alternative health initiatives because the company remains unconvinced about their cost-saving merits.

"At this stage of development, we are really not at that point to say that adding these services would reduce costs," Rambo said.

While insurers are reluctant to pay for alternative treatments, at least two of the major health care systems in the Milwaukee area have begun embracing them.

Philip Van Dyke, supervisor of massage therapy services for Aurora Health Care, said some patients save thousands of dollars by getting massages instead of automatically having surgery. For example, a person with back pain could spend upward of $10,000 between testing and the surgical procedure, but a block of six massages would cost $300 and may just do the trick, Van Dyke said.

"The savings are just astronomical compared to what the traditional health care costs could be," he said.

Advocates of alternative care point to the complementary goal of acting as a preventative measure against future health problems. Techniques that reduce stress, like meditation, and other programs to change unhealthy lifestyles, like smoking cessation or weight loss, can curb later health issues, said Dr. Gary Lewis, Covenant Healthcare System Inc.'s medical director for complementary services for southeastern Wisconsin.

Lewis said health care costs could be significantly reduced if more emphasis were placed on preventative care. He likened the health care industry to a cliff from which people keep falling, but no money is allocated to erect a fence at the top of the cliff because all the funds are spent caring for the injured at the bottom.

"In terms of prevention, instead of really waiting for treatment of disease when it occurs, we should address changes in lifestyle choices," Lewis said.

Lewis said health care providers have a tendency to favor "quick fixes" over long-term health improvement.

"The benefits of pharmaceuticals shouldn't be understated, but the 'quick fix' has made us oblivious to lifestyle and the cause of the problem," Lewis said. "There is so much economic incentive for them to do the lifestyle therapies."

Just how much that economic incentive is, however, is unclear. A relative dearth of reliable cost studies has made the alternative and complementary health care trend a tough sell to employers and insurers.

Humana's Rambo said more research is needed before Humana could justify adding more alternative practices.

"We haven't been able to really prove that, for example, adding a massage therapy benefit would decrease the overall cost of health care," Rambo said. "We might have more people going to get massages, and they may feel good. But it would add to the overall cost of health care because there's people getting massages that they wouldn't normally get."

Lewis agreed that further conclusive research is needed before alternative and complementary care is fully accepted. He said Covenant's new Center for Complementary Medicine, set to open in June in Mequon, would give attention to collecting outcomes data for research purposes.

Although traditional health insurance plans stick mainly with traditional health care practices, patients who prefer alternative care already have begun seeking financial help. Blue Cross & Blue Shield United of Wisconsin and Humana both contract with American WholeHealth Networks Inc. of Sterling, Va., to provide access to complementary and alternative practitioners. The program offers a discount of up to 30 percent for alternative services.

Some small businesses have been prodded by employees who want cheaper acupuncture. Helwig Carbon Products Inc., Milwaukee, offers its 300 employees an annual $250 reimbursement for alternative and complementary care, as well as the services of an on-site health care manager.

Nearly half of Helwig's work force is Asian, and their desire for non-Western medical options was a driving force in revamping the company's benefits program in January, said Chris Kramer, sales manager for Diversified Benefit Services Inc. of Hartland. Kramer handles employee reimbursement claims for Helwig.

"They were used to these procedures, and many were more comfortable with these procedures than with traditional Western medicine," he said.

Programs like Helwig's, which reimburses employees for services as diverse as acupressure and as simple as fitness club memberships, are especially beneficial to consumers because they force them to take a more proactive role in their health decisions, said Connie Roethel, a Mequon alternative care advocate.

With more education about alternative health care, Roethel said, the popularity of the methods would boom.

"A skeptical person may say, 'Well, that's just in your mind,'" Roethel said. "But when do we start listening to these people?"

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