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The health care industry has a variety of policies and

standards regarding coverages for alternative medicine

modalities. From a sociological standpoint, unconventional,

alternative, or unorthodox therapies refer to medical practices

that are not in conformity with the standards of the medical

community. The New England Journal of Medicine defines

unconventional therapies, “as medical interventions not taught

widely at U.S. medical schools or generally available at U.S. hospitals. Examples include acupuncture, chiropractic, and

massage therapy”(1993). Coverages vary widely among conventional

carriers, preferred providers as well as the omnipresent Health

Maintenance Organizations (”HMO”). The primary emphasis and, for

that matter, the only reason for the existence of insurance

companies is a single word, profit. More specifically, premiums

less costs provide the all important profit margin, the life

blood of the insurance industry. By not providing coverage for

the billion dollar industry of alternative treatments, insurance

companies are keeping the cost of the premiums down but at the

same time not allowing their customers to use complementary

treatments such as chiropractic to prevent or cure illness. The

more rigid and restrictive the policy provisos, the more

assurance for the companies that they will maximize their bottom

lines. Therefore, patients of alternative therapies as well as

doctors must show that such unconventional treatment provides

relief and prevention of illness. “The total projected out-of-

pocket expenditure for unconventional therapy plus

supplements(such as diet pills and megavitamins)was 10.3 billion

dollars in 1990. This is comparable to the out-of-pocket

expenditure for all hospital care in the United States in

1990($12.8 billion), and it is nearly half the amount spent out

of pocket for all physicians’ services in the United States($23.5

billion)”(nemj,1991). From this one may infer that society has

become fed up with inadequate results or side effects associated

with surgery and drugs which accompany the treatment of modern

medicine. So, in an effort to cope with the inadequate treatment

patients are receiving from conventional medicine, they are

seeking alternatives such as chiropractic for chronic illness and

pain. “Although most doctors wince when you mention

chiropractors, some fairly rigorous studies have shown their

manipulations of the spine to be effective in relieving lower-

back pain. Orthopedic surgeons have even been known to refer

patients to chiropractors, and some 30 U.S. hospitals have

chiropractors on staff”(Wallis,1991).

Relevant Policies and/or Practices

“In 1997, 42 percent of all alternative therapies used were

exclusively attributed to treatment of existing illness, whereas

58 percent were used to prevent future illness from occurring or

to maintain health and vitality” (JAMA, 1998). “The magnitude of

demand for alternative therapy is noteworthy, in light of the

relatively low rates of insurance coverage for these services”

(JAMA, 1998). Coverages vary widely depending on the policies

provided by the carriers. In my research, I contacted the Kern

County Superintendent of Schools, (”KCSOS”), Personnel Office to

inquire into the health policies provided to the nearly one

thousand employees of the office. There are a variety of options

available to each employee. The basic hospitalization plan used

by the majority of employees is the Blue Cross Prudent Buyer

Hospital Only plan. As required by State and Federal law, the

office is also required to make available approved HMO’s if

employees request them. To that end, the office has a large

number of employees enrolled in Kaiser-Permanente and Health Net

HMO’s. The administrative agency that provides the programs is

the Self Insured Schools of California, (”SISC”), which is a

cost-containment consortium of hundreds of California school

districts. Currently, SISC provides coverage for more than

thirty-five thousand employees and their eligible dependents. In

addition to medical coverages, the office also provides life,

vision, dental, prescription and mental and nervous policies.

The mental and nervous policy that is provided for each employee

and dependents is described as a “carve-out” benefit. Prior to

this type of policy utilization, the basic Blue Cross medical

plan provided very specific and limited mental and nervous

benefits. Carve-out benefits provide coverages for treatments

that would not be covered otherwise. Several companies came

forward with plans that were more comprehensive and cost-

effective and replaced the medical plan component. An additional

benefit was that there was a net premium savings. Three

companies, Pacificare, MCC and BHA, offer plans at comparable

rates which provide a variety of family and personal counseling

services which are more along the lines of preventative medicine

rather than the hospitalization plans that were offered under the

basic hospitalization plan. Employee unions have been very

receptive to these plans due to the cost-containment provisions

as well as the intervention value for the employees that they

represent. For example, an employee with an alcohol or drug

addiction problem can get confidential assistance to assist in

the resolution of these problems and avoid being disciplined for

job performance problems.

The basic medical plans offered by the KCSOS office provide

various levels of coverage for several forms of alternative

medicine. The Blue Cross Prudent Hospital Only plan provides

coverage as follows: “A doctor of medicine (M.D.) or a doctor of

osteopathy (D.O.) who is licensed to practice medicine or

osteopathy where the care is provided, or one of the following

providers, but only when the provider is licensed to practice

where the care is provided, is rendering a service within the

scope of that license, is providing a service for which benefits

are specified in this Plan Description, and when benefits would

be payable if the services were provided by a Physician as

defined above: a dentist, optometrist, dispensing optician,

podiatrist of chiropodist, psychologist, chiropractor,

acupuncturist(but only for acupuncture and for no other

services), certified registered nurse anesthetist, clinical

social worker*, marriage, family and child counselor*, physical

therapist*, speech pathologist*, audiologist*, occupational

therapist*, respiratory therapist*. Note: Services by the

providers indicated by asterisks (*) are covered only by the

referral of a Physician as defined above”(SISC III, 48).

“Health Net has partnered with American Specialty Health

Plans (ASHP) to offer Chiro Net quality, affordable

chiropractic coverage. With this program, you’re free to

obtain this care by selecting a participating chiropractor

from the Chiro Net directory. Although you’re always welcome

to consult your Primary Care Physician, you won’t need a

referral to see a participating chiropractor.

What’s covered

Office visits

$10 per visit

30 visits per year

There is a $50 annual chiropractic appliance allowance

toward the purchase of chiropractically necessary items such as

supports, collars, pillows, heel lifts, ice packs, cushions,

orthotics, rib belts and home traction units.

What’s not covered

Limitations and exclusions

Air conditioners, air purifiers, therapeutic mattresses,

vitamins, minerals, nutritional supplements, durable medical

equipment, appliances or comfort items

Conjunctive physical therapy not associated with spinal,

muscle or joint adjustment

Diagnostic scanning, MRI, CAT scans or thermography

Exams or treatment of strictly non-neuromusculoskeletal

disorders

Hypotherapy, behavioral training, sleep therapy, weight

programs, educational programs, nonmedical self-help or

self-care, or any self-help physical exercise training

Lab tests, X-rays, adjustments, physical therapy or other

services not chiropractically necessary or classified as

experimental

Pre-employment physical or vocational rehabilitation arising

from employment or covered under any public liability

insurance

Treatment for temporalmandibular joint syndrome (TMJ)

Treatment or services not authorized by ASHP or delivered by

an ASHP provider

This is only a summary”(HealthNet, 7).

Nowhere in the Health Net coverage guide did it mention

coverage, limitation, or exclusion of the numerous treatment

modalities of alternative medicine except for chiropractic

treatment, which it supported in explicit detail. From this one

may conclude that chiropractic is the only alternative treatment

that has established a beneficial reputation in possibly

preventing illness and promoting wellness in the western world.

An extremist might say because Health Net does not include any

other forms of alternative medicine, that these modes of

treatment are not generally accepted by the medical community or

deemed effective or appropriate in treating illness.

Kaiser Permanente’s coverage plan has a significantly larger

number of exclusions and limitations regarding treatment coverage

compared to Blue Cross and Health Net within the SISC

administrative agency. The exclusions section of Kaiser’s

coverage guide states in section i, “Chiropractic services and

services of a chiropractor,” which is in contrast to both Blue

Cross and Health Net, each of which fully recognize and provide

coverage for chiropractic services. In section j of the exclusion

section it seems that Kaiser is attempting to eliminate coverage

of all other alternative medicine treatment by stating,

“Experimental or Investigational Services and those procedures

not generally and customarily provided to patients residing in

the Service Area.”(Kaiser, 13) Their definition of Experimental

and Investigational Services is, “any service or item that is not

recognized in accord with generally accepted medical standards as

being safe and effective for use in the treatment of the

condition in question, whether or not the service is authorized

by law for use in testing or other studies on human patients; or

any service requiring approval by any governmental authority

prior to use when such approval has not been granted prior to

provision of the service or item.” (Kaiser, 27) This seems to be

an attempt to classify all other forms of alternative medicine

treatments, with the possible exclusion of chiropractic, as

experimental forms of treatment. If this proves to be a

fallacious statement, by concluding that section j was an attempt

to deem that alternative medicine as an experimental service;

then one might conclude that Kaiser dismisses alternative

medicine treatment altogether by not including them in their

coverage plan at all. Either way Kaiser must view alternative

medicine as being inadequate or inappropriate treatment for

illness, providing relief of symptoms or improving their patients

degree of health.

Preventive medicine, wellness and alternative therapies are

fundamental components of a growing national trend. According to

a survey conducted by The Journal of the American Medical

Association, “…use of at least 1 of 16 alternative therapies

during the previous year increased from 33.8 percent in 1990 to

42.1 percent in 1997, and the probability of users visiting an

alternative medicine practitioner increased from 36.3 percent to

46.3 percent” (1998). More and more Americans are seeking options

other than conventional forms of medical treatment. Conventional

or modern medicine can be defined as treatment that is widely

accepted by U.S. medical schools and insurance companies as being

beneficial to the treatment of disease and illness with

scientific evidence. “In 1993, the National Institutes of Health

chose Dr. Joe Jacobs to head their new Office of Alternative

Medicine. The office was created last year under pressure from a

Congress alarmed by the soaring cost of high-tech healing and the

frustrating fact that so many ailments such as: AIDS, cancer,

arthritis, back pain, which have yet to yield to standard

medicine”(Toufexis,1993). The cost of standard medical care has

risen dramatically. For example, a simple arthroscopic cartilage

repair on an outpatient basis costs in excess of five thousand

dollars for a thirty minute procedure. A simple Magnetic

Resonance Imaging, (”MRI”), costs over a thousand dollars. In

contrast, a visit to a chiropractor costs less than forty

dollars. The Journal of Occupational Medicine performed a study

comparing costs of treating back injuries with chiropractic and

traditional medicine. Using identical diagnostic codes for 3062

claims, the report reached the following conclusion: “For the

total data set, cost for care was significantly more for medical

claims, and compensation costs were ten-fold less for

chiropractic claims.”(1991).

Major Position or Argument

Is it better to exercise preventive medicine rather than

focus on curing disease after the fact? In response, a growing

number of people have concluded that it is a quality of life

decision for them to opt for optimizing their health rather than

seeking cures. According to the study that represented the use of

unconventional therapy for the 10 most frequently reported

principal medical conditions, published in the New England

Journal of Medicine, “…a full third of the respondents who used

unconventional therapy in 1990 did not use it for any of their

principal medical conditions”(nejm,1991). From this fact we can

infer that a substantial amount of unconventional therapy is used

for non-serious medical conditions, health promotion, or disease

prevention. “The probability that an individual patient who saw a

medical doctor also used unconventional therapy in 1990 was

higher than one in three for patients with anxiety(45 percent),

obesity(41 percent), back problems(36 percent), depression(35

percent), or chronic pain(34 percent), relaxation techniques,

chiropractic, and massage were the unconventional therapies used

most often in 1990″ (nejm,1993). How can the insurance companies

ignore the fact that, “an estimated number of ambulatory visits

to providers of unconventional therapy in 1990 was 425 million?

This number exceeds the estimated 388 million visits in 1990 to

all primary care physicians(general family practitioners,

pediatricians, and specialists in internal medicine) combined.

Also, if one assumes that charges for visits to providers of

alternative therapy were paid in full, Americans spent

approximately 11.7 billion dollars for these services in

1990″(nejm,1993). Nutrition stores have multiplied in the past

few years due to the growing demand for a variety of vitamins and

potions regarded by many as a viable means to fend off disease

and to improve on one’s daily health. Additionally, fitness

centers and exercise facilities have sprung up on every street

corner. Some are open twenty-four hours per day and provide

numerous forms of equipment, technical assistance and even

personal trainers to assist dedicated individuals in improving

their general well-being and appearance. Society has become aware

of the benefits and effectiveness of unconventional therapies

shown by a study that those who sought treatment from providers

of alternative medicine has seen the provider an average of ten

times in the past twelve months(nejm,1991).

Body of Paper

The American Chiropractic Association defines chiropractic

as follows: “Chiropractic is a health care discipline which

emphasizes the inherent recuperative power of the body to heal

itself without drugs or surgery.” “The practice of Chiropractic

focuses on the relationship between structure, (primarily the

spine), and function, (as coordinated by the nervous system), and

how that relationship affects the preservation and restoration of

health. In addition, Doctors of Chiropractic recognize the value

and responsibility of working in cooperation with other health

care providers when in the best interest of the patient.” (ACA,

1998). There can be little doubt that chiropractic treatment is