Considering the use of CAM therapy requires extensive investigation of your health insurance providers’ plans to determine if any portion of this treatment will be covered; and utilization of other agencies such as the National Center for Complementary and Alternative Medicine (NCCAM) that provides research based-evidence indicating that the use of CAM therapies are safe and effective. Complementary and alternative medical therapies have been shown to be effective in treating the side effects of the number one cause of death and one of the hardest diseases to treat today ? cancer.
Despite the billions of dollars that are spent on medical research, one out of every ten Americans developed cancer; and in spite of the trillions of dollars that have been spent on cancer research in this country (Goldberg, Reed, 2009-2014), the number of cancer cases have grown immensely. Currently, the numbers of cancer cases are one out of two for men and one out of three for women with traditional methods of treatment being surgical intervention, chemotherapy and radiation. There are several methods of alternative treatment that have proven to be beneficial in treating the side effects of chemotherapy.
For example, the use of acupuncture in relieving pain, stress, and anxiety can also be helpful in aiding breathing in lung cancer patients. Another alternative method of pain relief for headaches and stress as a result of cancer treatment is chiropractic care; diet and exercise, supplements of minerals, vitamins, fiber and nutrients can increase a patient’s resistance and make them less susceptible to infection. Yoga can also be beneficial in managing depression, anxiety and lowers the blood pressure; while stretching associated with yoga assists with strengthening breathing functions.
The problem with getting alternative treatments with a quantifiable improvement in the quality of life approved by more patients, even though the success rate is ten times higher than conventional treatment, is that the majority of the cost will be out-of-pocket for the patient (Goldberg, Reed, 2009-2014). Studies have shown that complementary and alternative medicine (CAM) therapies will cost about $5,000 per week for a one or two-month in-patient program; this is still less than in-patient cost at about $5,000 per day for conventional treatment.
What can be done to get the American health insurance providers to become more accepting of complementary and alternative medical therapies? While insurance providers as well as Medicare payers may spend thousands of dollars for surgical procedures followed by rounds of chemotherapy and radiation, alternative therapies are not considered as viable means of treatment for cancer patients. The medical industry needs to look at complementary and alternative methods of treatment that are being now being implemented as supplemental treatment protocols for cancer patients.
Complementary and alternative therapies are currently not covered by HMOs, PPOs or Medicare; and if a patient in the U. S. wanted to try these types of therapies, they would have to go outside the U. S. to other counties such as Germany and Canada. When you compare the cost of a heart bypass operation for upwards of a half-million each year and the $5,000 per day for CAM therapy, it doesn’t seem like such a good use of Medicare or health insurance funds. Even though, this is but a small portion of what conventional treatment costs, the possibility of a patient having to pay for all of their out-of-pocket health care costs are very real.
This is where the obstacles lay ? the insurance carriers and healthcare providers that are being compensated with billions of dollars do not want a change in the way things are now. Alternative medicine is also threatened by conventional physicians who refuse to embrace new medical concepts and carry the guilt of watching patients suffer and die. If insurance providers and healthcare plans begin to offer insurance “subsidies,” we could see a rise in the public making more visits to complementary and alternative medicine providers than they do for in-patient medical treatment services.
The biggest loser would be the pharmaceutical companies due to the reduction in drug use that only suppress symptoms and produce toxic side effects. In the complementary and alternative medical treatment therapies, drugs would only be used intermittently and not as a regular course of treatment. If there is a change in how physicians treat cancer patients, from sick-care to healthcare, acupuncture could also be prescribed to reduce nausea and vomiting when necessary as well as other forms of CAM therapy.
In order to improve their quality of life, alleviate symptoms of distress accompanying cancer treatment and to boost their immune system (Chih-Fen Ku, et. a, 201l), patient use of complementary and alternative medicine (CAM) for improvement and maintenance of health has increased among the general public in spite of debatable value, effectiveness and safety issues. I think that the use of CAM can be very valuable and beneficial to patients, but I do believe that more accurate studies need to be performed to sanction the triad of health care, i. e., quality, cost and access before more of the population can be confident with the use of CAM. Currently several states in the U. S. are conducting clinical trials that are being sponsored by the Southwest Oncology Group in collaboration with the National Institute on Cancer and the National Center for Complementary and Alternative Medicine (NCCAM) on the use of acupuncture in the treatment of joint pain in breast cancer patients. Studies of this nature are necessary to determine the effectiveness and benefits of acupuncture in the treatment of cancer patients.
Specifically, decrease of joint pain, long-term effects and safety and tolerance of acupuncture (Clinical Trials. gov). This article was very informative as it was written by a cancer survivor and a physician who is known as the “Voice of Alternative Medicine” and has written 18 books on Alternative Medicine, including a best-selling Alternative Medicine: The Definitive Guide. He has spent over 40 years traveling the world conducting truthful research on both conventional and alternative medical treatments for cancer patients.
His search for treatment methods that proved to be successful carried him mostly to Germany as their non-traditional treatment therapies seemed to work very well for treating his cancer as he is in remission for the second time in his fight with cancer. According to this author, cancer is Big Business and its’ allies are the pharmaceutical companies, the American Cancer Society , the American Medical Association as well as elements of the federal government, the National Cancer Institutes (NCI) and the Food and Drug Administration [(FDA) (Goldberg, Burton ,2009-2014)].
These organizations believe that only surgery, chemotherapy, radiation and gene therapy should be used to treat cancer and; subsequently, they control what information and treatments about cancer are made available to the public. Any form of treatment that is outside what these organizations deem as effective are branded ineffective or “unapproved,” despite overwhelming evidence to the contrary. I found this article interesting because it discusses different methods of Eastern Medicine compared to Western Medicine; however, it appears there needs to be more research done as to what its’ real benefits are.
For example, several forms of Traditional Chinese Medicine (TCM) such as acupuncture/acupressure or Chinese herbs, and massage or reflexology were reviewed and some small degree of effectiveness was found was in the use of mistletoe in the treatment of oncology. On the other hand, the use of acupuncture, Chinese medical herbs, mistletoe, massage, Qigong and selenium were conflicting and the use of reflexology, homeopathy and Laetrile did not produce positive results.
One method of Traditional Chinese Medicine (TCM), acupuncture, was proven to be very beneficial for the treatment of nausea and emesis following chemotherapy. This article provides insight into why a patient might choose to use the CAM treatment method. Primarily, the patients desire relief from their negative side effects of their cancer treatment. In order to determine which method is preferred above others and which ones are most beneficial, physicians need analyses of the supportive CAM therapy.
Studies of this nature have found that patients are not focused on their symptoms but rather one form of CAM based on their country of origin, social, cultural and medical background (and understanding). For example, patients in Europe tend to use natural products such as supplements and herbs; however, patients from Asian countries tend to utilize more traditional Chinese medicine such as acupuncture (Huebner, et. al. , 2013). Based on the high number of reviews on TCM, it appears that the use of TCM in the treatment of cancer patients is gaining more popularity in the western world.
These authors performed clinical studies on the survival rate of cancer patients treated with Iscador (fermented mistletoe extract) ; conversely, trials where a combination of Iscador and Helixor (aqueous mistletoe extracts) were used were excluded as the results were not favorable for patient use. A local injection of mistletoe is often used as a complementary approach in oncology although there are still controversial results about its clinical role on anti-tumor effects.
The results were tentative at best because of the lack of a standardized manufacturing process. Although studies indicated that the patient’s Qualify of Life (QoL) was much improved, the findings were inconsistent when it came of life expectancy, dosing and treatment duration. This article revealed the necessity of high quality research and funding to accomplish that task. According to the 2007 National Health Interview Survey (NHIS), U. S. adults spent an estimated $33.9 billion on out-of-pocket costs on complementary health approaches in the previous 12 months (National Center for Complementary and Alternative Medicine, 2013). Additionally, Americans spent 11. 2 percent of their total healthcare spending as out-of-pockets costs totaling one-third or ($11. 9 billion) on CAM treatment visits. Since traditional healthcare has not chosen to fully embrace CAM methods of treatment; and insurance coverage of complementary health approaches is confusing, contacting your health insurance provider might be the best place to start.
This article raises some valid questions that should be addressed by insurance providers and that patients should make themselves aware of prior to utilizing CAM healthcare practitioners. While some healthcare plans cover selected complementary treatment methods through the purchase of “riders” to the standard healthcare plans; others offer discounted out-of-pocket rates for CAM treatments. The National Cancer Institute provides a layman’s viewpoint on how the use of acupuncture and acupuncture points can be used to control symptoms in the treatment of cancer patients, i.e. , pain, fatigue, nausea and vomiting caused by chemotherapy, weight loss, anxiety, depression, insomnia, poor appetite, dry mouth, hot flashes, nerve problems and constipation and diarrhea. Acupuncture has been utilized for treatment of various issues in the United States for around 20 years; however, the Asian culture has used acupuncture as their traditional form of medical treatment for thousands of years.
The problem currently is that traditional healthcare insurance plans do not cover complementary and alternative (CAM) medical therapies and patients end up having to pay for these treatments out-of-pocket. One solution to this problem is for health insurance carriers to develop a group health plan to provide CAM therapy treatment for participants through a qualified health insurance plan that outlines the amount and method of reimbursement and the discount amounts for these therapies.
During the annual renewal period, employers could chose to negotiate with their insurance provider the offering of a nontraditional health insurance plan that would establish the criteria for which conditions are eligible for CAM coverage. This policy would include a contracted provider network that would agree to provide their services at a reduced cost for members of their organization; whether preapproval or referral by HMOs and PPOs would be required; or if a treating physician could order these treatments through the use of a written prescription.
Additionally, it should be determined whether or not CAM therapies would be covered in network or out of network and what the coverage limits would be; and the out of pocket discount rates would be an agreed upon amount equal to or less than the conventional treatment discount rates. Lastly, a tax exempt health savings account (HSA) could be established as a high-deductible health plan that could be maintained by the employer for those employees who desire CAM therapy coverage.
If traditional health insurance plans are just not an option, then these providers should make available an insurance rider that would provide coverage of CAM therapies that would offer a 20% discount on the cost of a CAM therapy treatment such as acupuncture for a specified number of visits if these visits were paid for through a Flexible Spending Account (FSA); CAM therapy providers could also arrange for payments over time or on a sliding-scale fee which are determined by the patient’s income and ability to pay and the remaining payment subsidized by the Federal Government.
I believe this is a viable solution because employees could be made aware of the CAM therapy option through the Employee Retirement Income Security Act (ERISA) because of its mandate to provide information to access and protection for participants through employee benefit plans. I believe this solution is justifiable because the people who are more inclined to use CAM therapies are those over the age of 65 and are currently having their health expenses covered by the Federal Government, such as programs for veterans, and through its welfare and Medicare/Medicaid programs.
If the consumer disagrees with the insurance providers’ denial of claim, the right to appeal is present. Working through the Human Resource (HR) department, the employee can dispute a denied claim for CAM therapy and ask for HR to take a look at implementing a change to the health care plan. Because there is power in numbers – a group of employees rallying together and voicing their concerns may encourage the employer to make a change in CAM therapy coverage and begin providing coverage.
There is no reason why changing from a traditional insurance plan to a nontraditional plan like a catastrophic or high-deductible plan could not be implemented because these type of plans keep deductibles very high, meaning premiums may be lower and therefore, more affordable to both the employer and the employee (in the long run, this will provide some form of coverage that may not be available without it). Implementation of either of these plans would be less expensive and have a lower deductible that would provide extra funds that could be used for CAM therapies as necessary. ? References Chih-Fen Ku & Koo, Malcolm (2011, November 9). Association of distress symptoms and use of Complementary medicine among patients with cancer. Journal of Clinical Nursing, 21, 5-6, 736–744, http://doi. org/10. 1111/j. 1365-2702. 2011. 03884. ClinicalTrials. gov. (2012, September 30). S1200: Acupuncture, Sham Acupuncture, or Wait List for Joint Symptoms Related to Aromatase Inhibitors in Patients W/Early-Stage Breast Cancer. Retrieved from http://clinicaltrials. gov/show/NCT01535066.
Forsch Komplementmed,16: 217-226. http://doi. org. 10. 1159/000226249. Retrieved from http://www. ncbi. nlm. nih. gov/pubmed/19729932. National Center for Complementary and Alternative Medicine (2013, October 13). Paying for Complementary Health Approaches. Retrieved from http://nccam. nih. gov/health/financial. National Cancer Institute at the National Institutes of Health (2013, August 6). Acupuncture (PDQ). Retrieved from http://www. cancer. gov/cancertopics/pdq/cam/acupuncture/patient.