Try these smart strategies to help get coverage for your hands-on back treatments
The nondrug back-pain treatments that people in CR’s survey often described as helpful are, unfortunately, less likely to be covered by insurance.
On average, people spent more than $200 out of pocket over the course of their full treatment for acupuncture, massage, or care from a chiropractor. Almost one in four spent $500 or more. That compares with about $80 that people spent out of pocket for care from an M.D.
A big barrier for many patients is that insurance companies often refuse to cover nondrug therapies, says Nitin Damle, M.D., a former president of the American College of Physicians, which recently issued new guidelines emphasizing hands-on treatments. But he’s “hopeful that the new guidelines will move the needle forward, so there is a shift from pharmacologic to nonpharmacologic treatment.”
Insurance companies often cover several visits for chiropractic care and physical therapy, but only very expensive plans tend to cover acupuncture, massage, and yoga, says Jim Redmond, regional vice president of communications and community investment at Excellus BlueCross BlueShield in New York.
There’s evidence that nondrug approaches not only work well but also make economic sense. A 2016 review of 33 studies found that exercise combined with psychological counseling, yoga, spinal manipulation, and acupuncture were cost-effective.
And a pilot program run by Excellus BlueCross BlueShield found that educating doctors about a restrained approach to back pain was paying off for patients and the bottom line. “Imaging, visits to specialists or the emergency room, surgery, opioid prescribing, and costs all decreased,” Redmond says, “while patient satisfaction went up.”
Still, for now there’s a good chance you’ll have to pay more out of your own pocket for hands-on nondrug approaches than for more standard care. Here are some tips to help minimize your costs:
Review your insurance policy. Insurers are more likely to cover chiropractic care and physical therapy than other nondrug therapies, but it’s worth checking. Thirteen percent of people in our survey who saw a massage therapist said that insurance picked up the tab for more than 75 percent of the cost.
Get a referral. Your doctor may need to refer you or contact your insurance company explaining why a nondrug treatment is medically necessary.
Look for discounts. Check with your insurer or employee wellness program to see whether it has negotiated reduced rates for therapies not covered by insurance. Also ask providers about discounts for multiple sessions.
Switch if you need to. If your coverage for one therapy runs out before your pain is gone, consider trying another that’s covered—say, switching from chiropractic care to physical therapy.
Consider the total cost. If you have a high-deductible plan that requires you to spend thousands out of pocket before insurance kicks in, nondrug treatments can be a good deal compared with conventional medical care.
Use tax-free dollars. You can use money in a health savings account (HSA) or flexible spending account (FSA) for most nondrug treatments. Keep a copy of the prescription or doctor’s note to prove that the treatment is for back pain.
Appeal. If your insurer refuses to pay for a service you think should be covered, you’re entitled to appeal. Check your insurance company’s website or call customer service.
Editor’s Note: This article also appeared in the June 2017 issue of Consumer Reports magazine.
This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).