Consumer Financial Issues in Complementary and Alternative Medicine - Insurance Company and CAM Treatment

Written by National Center for Complementary and Alternative Medicine

Page 4 of 8

8. My insurer has asked me for evidence, from scientific and medical literature, about the use of a CAM treatment. Can NCCAM provide this information?

The NCCAM Clearinghouse can help you find information from the scientific and medical literature on CAM. They use databases of peer-reviewed scientific and medical journals, such as CAM on PubMed (see "Resources"). If you do not have access to the Internet, the Clearinghouse can send information to you.

9. My insurance company has denied my claim for CAM treatment. Is there anything I can do?

As discussed in Question 3, make sure you know your policy--including what it is, and is not, supposed to cover. Check whether there has been a coding ³ error, either by the practitioner's office or by the insurance company; compare the codes on the practitioner's bill with the codes on the document you received from the insurance company. If you think your insurer made a mistake processing your claim, you can request a review from the company. Also, the insurance company should have an appeal procedure and provide a copy of it with your policy. It may be helpful to discuss with your practitioner whether she can do anything on your behalf, such as writing a letter. If you have taken these steps and the problem is not resolved, contact your state insurance commissioner's office, which has consumer complaint procedures.

³Health care providers and insurance companies use a standard set of codes in billing for medical services.

10. Are there laws to help me keep my health insurance if I lose or change jobs? Do these laws apply to CAM treatments?

If you currently have an insurance plan that includes any CAM coverage, the following laws may be of interest to you.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 offers limited protections for many employed Americans. HIPAA protects health insurance coverage for workers and their families if the worker changes or loses his job. The law:

Limits the ability of insurance companies to refuse coverage based on preexisting conditions.
Prevents group health plans from denying or charging more for coverage because of past or present poor health.
Assures renewal of coverage, regardless of any health conditions of people covered under the policy.
Guarantees certain small-business employers, and certain people who lose job-related coverage, the right to buy health insurance.

The Centers for Medicare & Medicaid Services (see "Resources") can provide you with general information on the Federal HIPAA program. Note that individual states may have specific laws related to HIPAA requirements; if you need more information on HIPAA in your state, contact your state insurance commissioner's office.

Another Federal law that may help you is the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. COBRA continuation coverage gives you the chance to buy and maintain your current group health coverage for a defined period of time if you are laid off or have your work hours reduced below the level for receiving benefits. The length of continuation coverage depends on the reason for your loss of group coverage. COBRA generally covers health plans of businesses with 20 or more employees, employee organizations, and state or local governments. You must meet certain application deadlines and other conditions, such as payment schedules, to maintain coverage under COBRA. COBRA also can help you avoid a gap in coverage if you change jobs and are not immediately eligible for coverage in your new company.

For more information about COBRA, contact your nearest office of the Pension and Welfare Benefits Administration of the Department of Labor (see "Resources"). Your state may also have a law that requires insurers to continue group plan coverage to individuals who lose their medical coverage for various reasons. Check with your state insurance commissioner's office.