As part of your cancer care, your health care team may have suggested integrative care services, such as acupuncture, massage, nutritional support or behavioral health counseling to address symptoms of your cancer or the side effects of treatment. Integrative care is often used in conjunction with standard-of-care cancer treatments such as chemotherapy or radiation therapy.
The National Institute of Health’s National Center for Complementary and Integrative Health website offers information on the science behind many supportive care services. Research has shown many of these practices may help patients maintain their strength during treatment, reduce pain and improve quality of life.
Many doctors, including oncologists, embrace the use of integrative care practices into their patients’ care plans, but not as stand-alone therapies. But not all these services are covered by insurance. To understand what may be covered, it is helpful to distinguish between integrative care and so-called alternative treatment options.
Some alternative practitioners may reject conventional medical treatments such as chemotherapy, radiation therapy or surgery, and instead recommend a special diet or herb, for instance, to treat cancer. These alternative approaches are often not covered by insurance to treat disease and may be untested or even harmful. The National Cancer Institute offers more on the differences between these modalities.
In this article, we’ll explore:
- Is integrative care covered by insurance?
- Does Medicare cover integrative care?
- How to find out if your insurer covers integrative care
If you’ve been diagnosed with cancer and are interested in a second opinion on your diagnosis and treatment plan, call us or chat online with a member of our team.
Is integrative care covered by insurance?
The National Institutes of Health estimates that Americans spend about $30.2 billion yearly out-of-pocket—without any insurance payment to offset the costs—on complementary health products and practices. These may include a visit to a chiropractor or massage therapist as well as vitamins and dietary supplements.
For those being treated for cancer, insurance coverage is especially important to help defray the financial burdens that may come with care. If your care team recommends integrative care services in addition to conventional treatments, it’s helpful to know up front what insurance will cover.
According to the American Cancer Society, the most commonly covered supportive therapies for cancer patients are acupuncture, massage and chiropractic services. Insurance coverage, however, will differ, possibly significantly, depending on your specific insurance policy or your employer’s plan.
Keep in mind that some integrative care services, such as those involving nutritional support or pain management, may be covered while others, such as nutritional supplements, may not be included. This means you will have to check directly with your insurer to fully understand your unique circumstances.
Insurance companies may be hesitant to cover some supportive care services for several reasons, some of which are mentioned in this editorial published in the American Society of Clinical Oncology journal Oncology Practice. For instance:
- The insurer may not have conducted a full cost-benefit analysis of the service.
- Reimbursement levels may be hard to calculate since those providing the services, such as massage therapists or acupuncturists, may charge a broad spectrum of fees.
- Licensure requirements for these practitioners as well as state insurance laws and mandates may vary widely from state to state.
It pays to fully understand and explore what your options are, including special supplemental coverage or “riders” that may be added to your insurance plan to include some integrative care therapies.
Even if your policy does not cover integrative care services, discount programs that allow you to pay less than the usual out-of-pocket fees may be available, so be sure to ask about any such opportunity.
If your insurance policy includes a flexible spending account (FSA) or health savings account (HSA), consider investigating whether integrative or complementary approaches are covered, and which ones, since this could offer a tax advantage in paying for such services.
Does Medicare cover integrative care?
Generally, Medicare Part A and Part B, do not cover supportive care services, except in very specific instances. For example:
- Medicare Part B will cover up to 20 acupuncture sessions each year, but only for chronic lower back pain that is not associated with any metastatic disease.
- Medicare will cover chiropractic care only if you have a slipped disc in your spine.
- Medicare does not cover massage therapy even when recommended by a doctor.
Medicare A and B may offer financial support to cover some costs for participation in clinical trials investigating experimental treatments, including some integrative therapies. Coverage is only for those trials that meet certain criteria and established Medicare standards.
Medicare Part C, also known as Medicare Advantage, which is administered by private insurance companies, may cover specific integrative therapies, but each plan varies, so check with your Medicare Advantage insurer to determine what services may be included and costs covered. Also, check with your state’s Medicaid office to see if any integrative therapies are covered by this joint federal-state funded government program for lower-income Americans.
Some states, including Alaska and Washington, have mandated insurance laws and, depending on how practitioners such as acupuncturists, chiropractors or naturopaths are licensed, insurance companies may be required to cover the services of these providers. The National Association of Insurance Commissioners provides a directory of every state’s Department of Insurance.
How to find out if your insurer covers integrative care
Before undergoing any treatment, find out what is covered by your specific insurance plan. You may be able to find some information on your plan’s website. It’s also a good idea to call your health insurance company to verify and clarify exactly what your plan will cover and what, if anything, you will need to pay out-of-pocket for a particular service.
Sometimes the insurance plan representative may ask for a code called a CPT or ICD-10 code that the doctor or health care professional uses to submit an insurance claim for the treatment or service performed. Ask your provider for the code in advance to have on hand when you call the insurance company.
To get the most out of your call to your insurance provider, keep the following questions in mind:
- What complementary or other services are covered for my diagnosis?
- Do these therapies need to be authorized or approved in advance?
- Do I need a prescription or referral from my doctor to access these services?
- Does the service or therapy need to be provided by an in-network practitioner?
- If I go to a practitioner who is out-of-network, will insurance cover any portion of the cost?
- Are there limits on number of treatments or visits or a maximum amount insurance will cover?
- What will I have to pay out-of-pocket in addition to what is covered by insurance?
If you find that your insurance does not cover an integrative care service and you decide to pay for it out-of-pocket, be sure to ask the person providing the service these questions before your initial visit:
- What does the initial visit cost?
- What does each subsequent appointment cost?
- Does the practitioner offer a sliding fee scale based on income?
- Are other fees for additional tests, supplements, etc. anticipated? If so, what will they be?
- How many appointments does the practitioner think will be needed to complete treatment?
- What, if any insurance, does the practitioner accept?
- If the provider accepts your insurance plan, will the office file the claims or is that the patient’s responsibility?
Clear lines of communication between you and your health care team will establish whether you might benefit from integrative therapies, while good communication with your insurer will help you navigate the financial aspects of these often-helpful treatments.
If you’ve been diagnosed with cancer and are interested in a second opinion on your diagnosis and treatment plan, call us or chat online with a member of our team.
