Getting Alternative Medicine Covered by Medical Insurance



Insurance pays over $100 billion every year for ineffectual or even harmful conventional medical treatments.

It is time to make proven alternative therapies affordable and available to everyone.


Would you join me in helping to rectify one of the great inequities of our time? This is the disparity between medical insurance coverage of alternative therapies compared with conventional treatments.

I receive thousands of e-mails, letters and phone calls every year from people asking all kinds of questions about alternative medicine. One of the questions I am asked most frequently does not have anything to do with how to treat any one particular health condition: it is how to get medical insurance to cover alternative therapies.

Every day I learn about exciting advances in alternative medicine, and hear inspiring stories of patients who have been cured of diseases conventional medicine calls "incurable." But what good are these medical miracles if people do not have the money to pay for them? Therefore, to make alternative medicine available to more people, I have started a not-for-profit foundation with the purpose of getting every state in the U.S. to pass legislation that requires insurance companies to cover alternative treatments on an equal footing with mainstream medicine.

In general, alternative medicine costs less than conventional treatments. It is more than ironic that it is more expensive to individuals because they must pay for it out-of-pocket: It is a tragedy. To see why, we have to look no further than the number one and two killers in this country: heart disease and cancer.

If you get cancer, your medical insurance or Medicare will pay for tens and hundreds of thousands of dollars of surgery, radiation and/or chemotherapy - whatever is the standard of practice for your particular kind of cancer. This in spite of the fact that after spending more than $2 billion annually for research over the last quarter century, the medical literature reveals that the incidence and mortality for most kinds of cancer remains unchanged - or continues to rise.

However, if you want to get treated at an alternative clinic where the success rate is upwards of ten times higher than conventional treatments - with the subsequent quality of life also immeasurably better - the cost could run $5,000 per week for a one or two-month in-patient program. This is still less than the cost of conventional treatment - for which hospitalization can cost upwards of $5,000 per day - but again, this would all have to come out of your pocket. And presently, it might have to occur out of the U.S., because many therapies that have proven effective abroad are not allowed to be practiced within our borders.

With heart disease, if you have a blocked artery, you can be one of the half-million or so people in this country every year who have a bypass operation that costs between $50,000 and $100,000 - and it will cost you little, if anything, because it is probably covered by your HMO, PPO or Medicare.

However, it is an entirely different story if you want to prevent or reverse coronary heart disease by going to an alternative physician. He or she would likely prescribe lifestyle changes, supplements and chelation therapy. A full examination, follow-ups, all lab work and a year's complete treatment could cost between $5,000 and $7,500. This is a fraction of what conventional treatment costs, but again, the chances are that you would be responsible for paying for all of it. That is, if you are lucky enough to live in one of 11 states in which a doctor can perform chelation therapy without risk of losing his or her medical license.

Yet, according to the federal government's General Accounting Office, less than 10% of bypass operations are necessary; and studies in mainstream medical literature show no significant difference in the death rates between heart attack victims who receive bypass surgery and those who do not. Still, approximately $4 billion dollars is spent on bypass surgery every year.

Here, of course, is where the difficulty lies. The people to whom these billions of dollars are being paid do not want a change in the status quo.

Those industries and occupations that have the most to lose include insurance carriers. Insurance companies make their money as a percentage of their gross revenues. From a business point of view, insurance companies would be most profitable insuring lots of sick people employing ineffective, expensive medicines.

Also threatened by alternative medical insurance coverage would be dyed-in-the-wool conventional doctors. There are, unfortunately, a significant portion who don't want to go back to school to learn an entirely new medical paradigm, and others who don't want to face the fact that in their ignorance or arrogance they have let many of their patients suffer or die unnecessarily. The public now makes more visits to alternative practitioners than to primary care conventional doctors, and spends more out-of-pocket for alternative services than they do for hospitalization services. Without the insurance "subsidy," conventional doctors would lose even more of their patients.

Pharmaceutical companies would be the biggest losers. Expensive patented drugs that only suppress symptoms and have toxic side effects would only be used in the rarest circumstances in alternative medicine. If there was a major shift in this country from sick-care to real healthcare, the drug giants would have to do what the tobacco companies have done to survive: Once it became common knowledge that their main product was poison, they had to diversify into entirely different businesses.

QUICK DEFINITION

Chelation Therapy: The intravenous administration of substances which bind to heavy metals, toxins and metabolic wastes in the blood stream, allowing them to be eliminated through the digestive tract. Common chelating agents are DMPS (2-3-dimercapto-1-propane-sulfonate) to remove mercury and EDTA (ethylenediaminetetraacetic acid) to remove other excess metals such as calcium, iron, lead, copper and arsenic.

There is formidable opposition, then, to getting alternative medical therapies covered by insurance - the pharmaceutical and insurance industries are among the very top political contributors on the national and state levels, with physicians' trade organizations major players, also. The monetary stakes are huge: $37 billion dollars are spent annually on direct medical costs for cancer treatment and an equivalent amount is spent treating heart disease. Conventional medicine in this country is an industry with annual revenues of hundreds of billions of dollars.

On the other hand, much of the public - and many doctors - do want more access to alternative medicine.

The following statistics were compiled and documented by health activist Monica Miller of Foundation for the Advancement of Innovative Medicine (faim.org):

  • 80% of medical students want training in complementary and alternative therapies ("CAM")
  • 70% of family physicians want training in CAM
  • 69% of Americans use nonconventional medical therapies
  • 67% of HMO's offer at least one form of CAM care
  • 64% of U.S. medical school offer courses in CAM
  • 60% of physicians have referred patients to CAM practitioners
  • 56% of Americans surveyed believe their health plans should cover alternative therapies
  • 29 health insurers and HMO's already cover some CAM therapies

So, it is possible to get alternative therapies covered by medical insurance - in fact, it has been done in one state. In 1993, Washington passed a state law requiring insurance policies to provide coverage for treatments and services by every category of licensed health care providers, starting in 1996. Washington currently licenses naturopathic doctors, acupuncturists, chiropractors, certified dietitians and nutritionists, massage therapists and midwives. A coalition of insurance providers immediately initiated a legal challenge to the legislation, but the law was upheld in a ruling earlier this year by the Washington Supreme Court.

Washington is the exception, however. And before we can get medical coverage for alternative therapies, we have to make alternative therapies themselves available! Presently, only eleven states have laws that protect patient access to alternative therapies from licensed physicians: Alaska, Colorado, Georgia, Massachusetts, New York, North Carolina, Ohio, Oklahoma, Oregon, Texas and Washington. Further, individual states vary widely in the licensing of health care practitioners other than M.D.'s - providers such as naturopaths, acupuncturists, homeopaths, etc., must also be recognized and their services included in insurance coverage. In addition, wording in insurance law and policies has to be defined by statute, so that, for example, "medical necessity" is something determined by the physician on a case-by-case basis, instead of by an insurance underwriter.

There is much work to do, and we are just getting started. To find out how you could help by volunteering your time or contributing to the foundation, please e-mail me at foundation@burtongoldberg.com.

Making alternative medicine available for everyone is more than a matter of money - it is no exaggeration to say that it's a matter of life and death.

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