People's attention has turned to alternative treatments as the number of diseases we see in modern life has increased. These days, alternative medicine is prevalent, especially for chronic illnesses. However, there is a cost associated with both types of treatment, whether you choose an allopathic or alternative approach. Most of us purchase health insurance to cover the cost of care if we become ill or are injured in an accident. But previously, only allopathic care (western medicine) was covered by health insurance plans, and AYUSH was omitted.
At that time, in addition to paying the premium for comprehensive health insurance, you also had to pay the cost of any alternative treatments you chose. The current state of affairs has improved and given the holders of health insurance some relief. Most health insurance providers today provide coverage for alternative therapies.
What are Alternative Therapies?
There are numerous names for alternative medicine. Some titles include alternative and complementary, integrative, functional, and holistic medicine. Various medicinal modalities include aromatherapy, biofield therapies, biofeedback, dietary supplements, guided imagery, electromagnetic therapy, homeopathy, meditation, hypnotherapy, naturopathy, relaxation training, nutritional counseling, yoga and even traditional Chinese medicine.
With the release of a new directive in 2013, alternative medical care was covered under health insurance plans. As a result, many health insurance companies now offer AYUSH treatments- Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. Alternative treatments can efficiently treat many lifestyle diseases. Many people in our nation prefer these conventional, western medicines to traditional, alternative ones because they are safer, address the disease's underlying causes, and don't have any adverse side effects. But such treatments come with a cost that can sometimes be hefty. This is where the role of health insurance comes into the picture.
However, due to the difficulties in providing alternative care, most insurers still do not offer such coverage. Moreover, even if the insurance plan covers the alternative treatment, insurance companies have a lot of terms and restrictions. Why this?
1. Most alternative therapies are outside the scope of standard medical care and are not covered by health insurance plans.
2. Treatment costs vary depending on the therapy and practitioner, making it challenging to estimate or verify expenses.
3. Alternative treatments lack a central governing body, which makes it difficult for insurance companies to subsidize such coverage.
4. Many patients combine conventional medical care with alternative therapies, making it more difficult for standard health insurance to provide coverage.
How Do Insurance Companies Cover the Cost of Alternative Treatment?
Ayurvedic and homeopathic treatments are usually unavailable to individual customers, but they are considered under group health insurance plans by a few health insurers. In addition, health insurance companies are addressing a specific market niche by including traditional medicines in individual plans. To be eligible to receive payment for the care received, one must be admitted to a recognized hospital for more than 24 hours. Some insurers also demand that the treatment has some successful remedial effects before they will approve a claim.
Traditional health insurance must be purchased to receive coverage for non-allopathic medications. Then, the patient must have received treatment in a government hospital or facility that has received government recognition to be eligible for coverage for alternative therapies. Additionally, patients can receive treatment at facilities accredited by the National Accreditation Board of Health (NABH) and the Quality Council of India (QCI).
Hospitalization costs for diagnostics or investigation are not reimbursed. The only costs that are covered are those related to the actual treatment. Also, the costs will not be reimbursed if the treatment is received at a healthcare facility that is not a hospital. Plans usually demand that the practitioner be licensed, even if they are not medical professionals. Your insurer may reject a claim for treatment if they believe it to be experimental or unproven. If so, you and your doctor might be able to convince the insurer that the treatment is effective based on the available data.
The coverage you can get for an alternative treatment under health insurance varies from one insurance company to another. For instance, some companies offer to cover only Ayurvedic medicines, but others provide to cover the cost of AYUSH treatments. Also, there can be capping in various health insurance policies for such treatments. Currently, 7.5%-25% of the total sum insured is paid by some insurers under alternative treatment claims.
Exclusions from Traditional Health Cover
The insurer does not cover the following conventional therapies:
1. Naturopathy
2. Comfort treatments like oil massages, steam rooms, and saunas
3. Hospitalization exclusively for diagnostics purposes
4. Received treatment outside of India
Things to Consider Before Treatment
Health care plans vary. For instance, some insurance plans pay for acupuncture while others don't. Contact your plan's member services representative, review your plan documents, or visit the plan website before undergoing an alternative treatment. Figure out:
1. Does your insurance cover that procedure?
2. Are there any particular requirements, such as obtaining preauthorization, a prescription, or a referral from your doctor?
3. Is there a list of restrictions on the number of visits or the amount your plan will cover?
4. Are there practitioners of alternative therapy in the network of your insurance plan? (A network is a collection of providers who have consented to accept the contracted rate from your plan as full payment.) If so, what are their names and ways to get in touch with them?
Conclusion
Allopathy isn't always the best option, so you should be able to explore alternative medical practices to see which ones best meet your needs. Select a health insurance policy that provides you with such a choice and doesn't impose restrictions on your well-being. Although the insurance coverage for conventional treatments has increased, there are restrictions on the sums covered and the circumstances in which they might be used. To ensure a simple claim settlement, you must carefully verify the treatments that insurers cover.
