I’m choosing a health plan, my first. Would love a little input on the topic.
In the past, when I’ve had the cash, I have self-paid for massage therapy and ART with great results, usually at the office of an athlete oriented chiro office. I’ve never had bad results from the chiro treatment when I got that, but the ART and painful massage was where I really perceived benefit.
Now, I’d like to have some degree of coverage for this so regular sessions would be affordable, but seems it’s just not available? Is that the case?
“Alternative therapy” is apparently a distinct type of treatment. It either is or is not covered as part of a given plan. Where it is covered by a plan it is typically acupuncture and nothing else. And, “massage therapy” is often specifically excluded as an alternative therapy not covered. This regardless of whether the plan would allow me to self-refer to a specialist. IOW, an ART practitioner is not a specialist to whom I can self-refer and have any coverage.
I can’t discern what might be considered “physical therapy,” whether or under what circumstances pt would include massage therapy and/or ART. I’m guessing never.
Surprisingly, I’ve thought chiro was somewhat controversial but I’m finding quite a few plans will cover chiro, and some states require insurers offer it. Often it’s limited to the manipulation tho some will cover electro stim and the like.
I was very surprised that my health plan includes ART sessions. I do have to pay a $30 co-pay for each visit. Now most of my ART sessions are very short. I probably am with the chiropractor only 10 minutes. I don’t know what he is actually charging my insurance carrier. I guess it probably is in the statements I receive but I don’t look at them.
For PT my insurance company has no co-pay. It is completely free to me. What is shocking is that our insurance carrier has a co-pay for pretty much every single other thing. I think every other thing.
This might surprise you but I don’t believe the insurance company should be paying for either. I don’t need ART or PT for my regular life. I only use them because I choose to do triathlons which my body has a difficult time supporting.
I do think the insurance company should pay for PT when it is needed from a “regular” life style. What bothers me is that my insurance company is offering less benefits for other things by providing such good benefits for these things.
I will tell you that when I have used PT I do go for far less follow up than other people. They give me the exercises and I do them on my own and only follow up as needed. When at the PT I do notice that many people there have the PT basically do the exercises on them instead of them taking responsibility of doing them.
Its basically advertising. When Insurance companies go to large companies where the employees have a choice between companies, one of the first questions they get is if they cover chiro (and other alternatives).
For a coverage without a primary care Dr putting a very high deductible/ low maximum allows them to answer yes. For a HMO or similar they will also say yes, its covered as long as your primary dr recommends it, which wont ever happen.
I’m happy to hear of the coverage being out there. If you don’t mind sharing, what insurer are you under?
This might surprise you but I don’t believe the insurance company should be paying for either. I don’t need ART or PT for my regular life. I only use them because I choose to do triathlons which my body has a difficult time supporting. ← yeah, the ins cos would def agree with you, tho this could be argued, and probably has been over in the lav room, not something I’m trying to stir up here, tho I’ll note that I’m willing to pay within a premium and copay. Not all tri-related issues for me either, e.g., an acute shoulder injury from snow shoveling that I’m pretty sure would benefit from PT/ART. Swimming would def be one upside to getting that addressed, as I haven’t been in the pool since (~2yrs yikes).
Amen re core work, foam roller, etc. Every damn day of my life. It helps. In tandem with ART/PT, even more.
The kind of plan descriptions I’m finding:
Chiro coverage - “Manipulation of the spine and extremities; Adjunctive procedures such as ultrasound, electric muscle stimulation, vibratory therapy and cold pack application. Chiropractic services limited to 20 visits per member per calendar year. You pay $35 per specialist visit.”
Alternative treatments - “Acupuncture by a doctor of medicine, doctor of osteopathy or licensed acupuncturist for pain relief. Benefits are limited to 12 visits per person, per calendar year. Note: Visits that you pay for while meeting your calendar year deductible count toward the 12 visit limit. PPO: You pay 10% of the plan allowance and all charges in excess of the 12 visit limitation. Non-PPO: You pay 30% of the plan allowance and any difference between our allowance and the billed amount and all charges in excess of the 12 visit limitation.
Not covered: Naturopathic practitioner; Massage therapist; Any charges in excess of the visit limitation for covered acupuncture and chiropractic services.
Note: Benefits of certain alternative treatment providers may be covered in medically underserved areas.”
I have Anthem Blue Cross. They make a big deal that they cover chiro (including ART), but here’s what they cover:
Up to $50/visit…with a $25 deductible. So my $100 ART sessions basically cost me $75 each. It’s a 25% discount, but hardly “covered” IMO.
For Anthem BC, it depends on the plan, so make sure look at the details of each plan. ClearProtection (my plan) for example specifically states it does not cover chiro.
Mine does (or at least did the last time I looked into it), but the copay ($50 for a ‘specialist’) is more than the “cash at the door” cost ($40 for a 20 minute session), so I just pay cash.
I do however put money into my FSA that covers that $40 (and my dental, which is also cheaper to pay cash at the door vs the insurance). So at least it is tax free.
Frankly, you need to discuss this with your provider. In some cases, providers will bill certain procedure codes that reflect manual manipulation, PT services, etc. that may in fact be ART or like services. The payers, i.e. insurance companies only know the codes that the provider of service bills when it comes to claim processing. So if a provider bills a traditional PT CPT code that shows PT services, but it was actually ART, you claim will likely be processed as normal PT services. I am not making billing suggestions, however most DC or PT providers understand this, don’t be afraid to discuss this with them. No offense, but if there is one thing these providers understand it is how to code to maximumize reimbursement and serial utilization. That is also why you will might find higher plan scutiny of DCs providing these services vs. say a hospital based PT unit.
Because of abuses, you plan may limited the number of covered units for PT services and require a higher copay in an effort to curtail utilziation.
The payers, i.e. insurance companies only know the codes that the provider of service bills when it comes to claim processing. So if a provider bills a traditional PT CPT code that shows PT services, but it was actually ART, you claim will likely be processed as normal PT services. <<
Exactly.
My chiro also does ART and it’s covered. I have Cigna PPO or something like that.
HSA or similar is the way to go. Depending on the state ( and it does depend on the state - blue cross colorado is not the same as blue cross michigan ) chances are after the additional premiu s, co-pays, and deductibles a lot of alternative therapies, dental, and vision are not any cheaper than paying out of pocket in the long run. Especially because most doctors offer un advertised cash discounts.
Most plans have some Chiro coverage, but will never cover ART specifically. However many will just bill another code or include it as part of the other treatment.
For the poster that brought up the “should it be covered for you” issue.
For triathletes and such, it is an extracurricular life style choice so to speak - so you could look at it as a cost of doing the sport. An additional expense like pool memberships, gu, co2, and race fees - which will help your recover and preform in the long run, a solid investment.
The cost of that kind of care is small compared to health risk and procedures of people leaving seditary lifes. Why not cover preventative or palliative care for someone going for a significantly healthier life style? I mean, the cost of one trip to the ER for someone that is overweight sedentary and thinks they are having a heart attack but is just experiencing indigestion and heart burn is probably close to a lifetime of Chiro, massage, and a gym membership.
I’ve often wondered why health insurance doesn’t include gym access - or why they haven’t built their own gyms - the per person pay out for a heather insurance carrier has to justify the benefit there.