Why doesn’t health insurance cover what you want?

by Denise O’Malley, Founder of You Define Wellness and a Reformed Insurance Agent

“Why doesn’t health insurance cover alternative medicine?”  That was the question two people asked me recently in two separate conversations.  Here’s how I responded.

Let me set up scenario #1 for you.  A gentleman was telling me about a conversation with his wife who asked the question above.  

Me: “Do you want to look like a genius to your wife? I’ll share the reason.”

Him: “Absolutely! Please tell me!”

Me: “Money.”

The reason – in my honest opinion – is money… there isn’t a substantial amount of money in the alternative care industry. 

Think about it… when was the last time you saw a national TV ad for healthy living products and services? I’m not talking about the $9.99 gym memberships, weight loss ‘program’s, or hearing aid companies.  I’m talking about the thousands of small businesses that comprise the health & wellness industry.

  • Personal trainers
  • Health coaches / Dieticians
  • Mental health counselors
  • Spiritual coaches
  • and hundreds of other healing modalities

Let’s look for a moment at the common denominator of what IS included in health insurance: services that are qualified medical expenses as defined by Internal Revenue Code.  In order to be included in the list of qualified medical expenses (IRS Pub 502), Congress has to change the Code and they are not motivated to do so.  What motivates them? Money, specifically from powerful lobby organizations like those employed by pharmaceutical, health insurance, and the AMA.

Yes, I actually tried to change the Internal Revenue Code…

About four years ago, I submitted a proposal to modify the definition of qualified medical expenses to my local Congressman… and his Chief of Staff was REALLY excited about my proposal.  We met several times with a forewarning to not become emotionally attached to the outcome advising me that when presented to Congress, a more powerful Representative would hijack the proposal as his/her own.  No problem… I just wanted the Code to be changed to allow healthy living expenses to be deemed qualified medical expenses, I didn’t care who got the credit.

Ultimately my proposal was declined until I could produce studies from a reputable source that illustrated how a focus on healthy living could reduce medical claim costs… or a million letters from constituents sharing their personal stories of health transformation.

< Sigh >

SCENARIO #2

Scenario #2 was slightly different. My companion was stating how a local health insurance company in her town DOES support alternative care by allowing chiropractic, acupuncture & massage therapy.

Me: “Most health insurance companies do now, but with limitations and restrictions such as requiring a doctor’s note for massage therapy.”

Her (after looking at her policy): “You’re right, it does say you need a doctor’s note for massage!”

Me: “The downside is many of the alternative care providers are dropping the health insurance companies after discovering they are told how much they’re going to earn (and it’s always way less than retail rates), and it can take weeks to get paid by the insurance company.”

I went on to explain that after 30+ years in the insurance industry and ‘seeing how the sausage was made’, I left. I’d witnessed how the two most important people in the transaction of health care – the patient and the provider – do not matter from the insurance company point of view.

Now this is a broad statement and I recognize the fact it’s not ALWAYS true, but on a broad stroke view of the industry, it is true.

One last point I’d like to make: many health care sharing pools DO promote that alternative care is included in their programs… but read the fine print.  Some use the words “may be included” and must be pre-approved by the company.  When I pressed for clarification on this verbiage with one highly popular company, they admitted that care beyond chiropractic or acupuncture would probably not be approved as well as massage therapy for maintenance purposes.  READ THE FINE PRINT AND ASK QUESTIONS!

SUMMARY

For the record I want to be clear that I am NOT against health insurance or allopathic (traditional) health care… both are necessary for the world we live in today.  I AM against the system that makes it difficult for individuals to pay for the care that they deem necessary in their lives.  Understanding why things are they way they are is a necessary first step in manifesting change.

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