But there’s good news. Beyond the annual physical and some wellness benefits, there are some great advantages hidden deep in most policies, things that you’ll actually want to use to improve your health. While most of us would rather drive a cranky relative to the airport than closely read an insurance policy, there is valuable information to be discovered if you’ll only take a moment.
The better news is that the insurance company wants you to use these benefits. That’s why they’re in the policy, in the belief that they will provide a greater quality of health care and thus reduce your overall cost from various acquired ailments.
These include so-called “alternative medicine” benefits that may once have been viewed as pseudo-science but now have moved comfortably into the mainstream as scientific research has uncovered their positive effects.
More Americans than ever are tuning in to the benefits of insurance coverage, thanks to the Affordable Care Act, popularly known as Obamacare. Gallup, the respected polling organization, reports that only 12.9 percent of U.S. adults were uninsured in the fourth quarter of 2014, down slightly from the same year’s third-quarter results but dropping significantly from the same period a year earlier. Gallup surveyed more than 43,000 people from Oct. 1 to Dec. 30, 2014, to obtain its survey results.
Check Policies Carefully
Unfortunately, because insurance coverage varies widely from state to state and employer to employer, there’s no one resource to track down what the hidden special benefits lurking in your policy may be. Most plans are mandated under the Affordable Care Act passed in 2010 at least to cover partially such benefits as emergency services, hospitalization, prescription drugs, pediatric and laboratory services, rehabilitation and physical therapy, and mental health counseling.
Some states take it one step beyond and require even more benefits, and your company may insert some perks that it believes will help them keep overall premiums down. Some policies will require you to pay upfront and then wait for reimbursement, either full or partial, which may put the brakes on your plans in some cases if you’re struggling financially.
But whether you buy as an individual or through the marketplace, it’s worth perusing your policy to see if the following are covered:
1) Acupuncture: This centuries-old treatment involves inserting thin needles at various pressure points on the body. The goal is to restore the balance of yin and yang by unblocking the rivers of energy known as Qi. Western medicine didn’t pay much attention to acupuncture until the 1970s, but since then, research has proven its benefits for certain conditions, including pain relief, pregnancy nausea, post-operative conditions (including dental surgery), chemotherapy side effects, arthritis, back pain and migraines, among others. As with all insurance issues, make sure you go to a recommended provider and check with the insurance company on what is covered and how to obtain the benefit. You may get discounts up to half-off the price of acupuncture.
2) Massages: For chronic pain conditions, a licensed professional massage therapist can really work out the kinks. This is one of those benefits that needs a sign-off on the insurance food chain, but there are documented medical benefits to working out the knots via Swedish, Shiatsu and other forms of massage, which generally fall under physical therapy benefits.
3) Gym Memberships: Many insurances companies recognize the enormous benefits of staying active and maintaining a healthy lifestyle. Thus, they’re willing to subsidize your gym or offer rebates for faithful attendance at preferred providers. Check with the company and find out what is offered and how you can benefit. Your plan may offer benefits at community centers as well as commercial facilities.
4) Yoga and Pilates – If you have a diagnosed condition and are approved by your physician, you may be eligible for classes that will help you stay limber and improve your overall fitness levels. Your health insurance will cover studios and fitness trainers for certain conditions that require this type of physical therapy but typically only for recommended vendors and for a limited time
5) Reiki: This is the Japanese art of vibrational healing with positive energy. It has a wide range of benefits, and while it’s still a bit on the fringes of alternative medicine therapies, some progressive insurance companies are willing to help with your sessions, particularly in cases where palliative care is necessary. There typically is a list of approved facilities and vendors, and this must usually be recommended by your physician.
6) Reconstructive surgery – No, you can’t get a cosmetic nose job or breast augmentation. These are elective surgeries, and while your self-esteem may be boosted by looking better, there are no urgent health benefits. However, if you’ve been in an accident, have an underlying medical condition that has manifested physically, or may have developed some sort of genetic deformity, there may be some help tucked away in your policy. These generally include reconstruction after surgery or cosmetic issues like a cleft lip or palate. If, after the surgery, you need help with speech or cognitive therapy, compensation may be available.
7) Travel expenses for specialized surgery: There are sometimes major or intricate surgeries that are available only at specialized clinics or from certain doctors. You insurance plan may cover the transportation and lodging to reach those locations, albeit with a cap on coverage. All must be approved, and the insurance company typically has a preferred carrier for such services.
8) Weight-loss surgery – Some health plans are beginning to add gastric bypass or lap band surgery coverage to their benefits. The procedure must be medically necessary and physician directed, typically because of the fears of Type 2 diabetes, high blood pressure or other medical conditions that may be exacerbated by excess weight.
Of course, conditions and plans are constantly changing, so get any compensation confirmed in writing. But as insurance moves from reactive to pro-active planning, more and more benefits that formerly were considered outside the realm of care should become available. Keep an eye on your policy and ask questions of your broker to determine which may be available to you and your family.