Path to Alternative Therapies Is Littered With Obstacles

November 13, 2009

WHEN Diane Klenke was told five years ago that she had pancreatic cancer, she was given three months to live. “The doctor told me to go home and put my affairs in order and that was it,” Ms. Klenke, now 52, remembered.

Instead of taking that advice, Ms. Klenke, who lives in Green Bay, Wis., decided to fight. She researched other doctors and alternative therapies until she hit upon the Block Center for Integrative Cancer Care in Evanston, Ill., which uses an approach of traditional and holistic therapies to treat cancer patients.

After undergoing intense chemotherapy along with propernutrition, nausea and stress management therapies at the Block Center, Ms. Klenke’s cancer went into remission and has stayed that way.

So where is this anecdote heading? Glad you asked.

Cancer and its treatment are so complicated and relatively unpredictable that this column is in no way meant to advocate Ms. Klenke’s approach to dealing with her disease.

As a Patient Money columnist, I don’t pretend to have that expertise.

Instead, my purpose here is to provide financial guidance for those who, like Ms. Klenke, choose to take the medical path less traveled.

Besides learning the ins and outs of complementary andalternative medicine, Ms. Klenke has also become something of an expert on how to pay for these treatments. With the help of the Block center and her own research and persistence, she persuaded her insurance company to cover her entire course of treatment and the follow-up treatments that she continues to pursue, as she puts it, “to boost my immune system and keep me cancer-free.”

So-called complementary and alternative medicine — or CAM, as it is known by practitioners and adherents — is becoming more mainstream every day. In 2007, more than one in three adults and nearly one in eight children, according to a federal study sponsored by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, used some form of CAM — from self-prescribed nutritional substitutes to repeat visits to alternative health care practitioners. So commonplace are the alternative providers that chiropractors and acupuncturists, for example, are now licensed by most states. At the same time, many traditional medical doctors, recognizing patients’ demand for alternative therapies, have signed up for training in alternative therapies or added alternative professionals to their staffs.

Alternative medicine is also a big business. Americans spent nearly $40 billion out of pocket on alternative therapies, according to that same 2007 study, to pay for practitioners as well as vitamins and supplements. Often, the treatments aren’t cheap. A session at the acupuncturist can easily run $100. And as with pharmaceuticals, vitamins, herbal supplements and homeopathic remedies have a huge price range — from a $12 bottle of vitamins to supplements costing hundreds of dollars.

More insurance companies are now offering full or limited coverage, or arranging discounts, on these treatments. But, as Ms. Klenke learned, getting even limited coverage can be time-consuming and tricky.

And most people pursuing alternative therapies should expect to pay some, if not all, costs out of pocket, says Mark Stengler, a naturopathic doctor in the La Jolla area of San Diego who is licensed in California. He holds a doctorate from the National College of Naturopathic Medicine, now called the National College of Natural Medicine, in Portland, Ore. Naturopathic training is often similar to the training conventional doctors receive and includes holistic training. Dr. Stengler is the author of several books and the Bottom Line newsletter on natural healing. If you venture forth, here’s advice on how to make the most of your insurance coverage and find the best prices for the highest-quality alternative treatments and medicines.

INSURANCE INS AND OUTS Before you do anything, be sure to read your health insurance policy thoroughly. It may spell out some of the alternative practitioners and treatments it covers, for example, 50 percent of all acupuncture and chiropractor visits.

More often, says Linda Bourdosis, a patient advocate at the Block Center, coverage is more subtle. For instance, your insurer may pay for certain specific treatments — massage therapy for muscle strains, for instance, or fish oil supplements to reduce inflammation from arthritis — if they are prescribed by your primary physician for a diagnosed ailment and coded correctly. Many require preauthorization from the insurer.

Keep at it, Ms. Bourdosis says. Getting the insurer to pay “doesn’t always happen the first time,” she said. “It can take two, three or four claims. You’ve got to be persistent.”

Don’t be afraid to negotiate with your insurer and with your provider, particularly when treating serious illnesses. Ask to speak to the claims manager or your case manager. In Ms. Klenke’s case, the Block Center was willing to discount its rates 25 percent in return for being considered part of the network that Ms. Klenke belonged to through her husband’s group insurance plan. In her case, Ms. Bourdosis at the Block Center negotiated with her insurer, but sometimes the patient needs to be the middle man to get an insurer and health care provider to agree.

Or, you might want to try to find an alternative practitioner who is part of a larger group of traditional doctors, or vice versa, Dr. Stengler says. That way, if you need lab tests or other diagnostics, your primary physician can prescribe them and they will be covered — even if alternative treatments are not.

COMENT

This is a piece of news published in THE NEW YORK TIMES newspaper on 13^th November 2009. In this news is spoken of as a woman has managed to dodge many difficulties, mainly economic in tackling costs, both of chemotherapy as alternative therapies that have been submitted by their own will.

This person is a clear reflection of a large part of society, in the sense that a normal woman has to pay out of pocket, mostly, but can receive aid from the insurer.

It should be known that this type of alternative therapies, although they are used increasingly more often by great diversity of people, their costs are still higher than conventional medical treatments.

Advocates of alternative medicine hold that the various alternative methods are effective in treating a wide range of minor and major ailments, and argue that recently published research demonstrating the effectiveness of specific alternative treatments.

They say it can provide health benefits through the active participation of the patient, offering more options to the public, including treatments that simply are not available in conventional medicine.

For all this, in my opinion, must take into account all considerations before putting time and money involved. We must learn before all kinds of treatments, many alternative and conventional, about the effectiveness, side effects, etc.