Read the fine print: Your plan might surprise you.(ISTOCKPHOTO)
Chances are, doctor visits and prescriptions are not all your health insurance plan has to offer. Many plans today offer disease management programs, improved coverage for mental health conditions and infertility, and much more. Be sure to ask about these benefits, because they may not be well publicized by your insurer.
A buzzword in the insurance world these days is "disease management," which refers to programs that help health-plan members with chronic conditions, such as diabetes or asthma. For diabetics, this benefit could range from a counseling session on nutrition to a full-fledged program including blood monitoring and nurse consultations. Unfortunately, the buzz is often used in selling the plans to employers rather than to employees, many of whom are unaware that these programs exist. "There is a lot of sizzle on the marketing side, but customer service is often not really geared for it at this point. It's incumbent upon the member to inquire whether there is a disease management program," says Nancy Fase Guernon, director of operations at CareCounsel, a health-care advocacy outsourcing company.
Better mental health benefits
In the past, many benefit plans limited or excluded coverage for mental health conditions. Thanks to the Mental Health Parity and Addiction Equity Act, as of 2010 some insurance plans will be required to offer mental health benefits equivalent to those they provide for conditions such as cancer and heart disease. The new law is expected to expand access to treatment for conditions such as schizophrenia, bipolar disorder, eating disorders, and autism. "The parity act says that if insurers cover medical or surgical benefits, they have to cover mental diagnoses at an equal level," adds Fase Guernon. Some states supplement federal law by passing their own parity laws, she notes, so check with your state department of insurance to determine the level of coverage to which you're entitled.
Coverage for trying to conceive
For couples relying on assisted reproductive technology such as in vitro fertilization (IVF), the cost of treatment can be prohibitive. One cycle of IVF, for example, costs $12,400 on average, according to the American Society for Reproductive Medicine. Fourteen states, including New York and New Jersey, have passed legislation requiring insurers to offer some level of coverage for infertility diagnosis and treatment. In most states, these laws include paying for IVF (although California and New York specifically exclude IVF). For a state-by-state summary of laws related to infertility therapy, visit Resolve (a national infertility association), or the National Council of State Legislatures.
Complementary and alternative medicine (CAM)
A growing number of insurers now cover alternative and complementary treatments such as chiropractic, massage therapy, herbal medicine, and acupuncture, which has been proven to alleviate pain and can ease chemotherapy-induced symptoms such as dry mouth.
You should be aware that coverage of CAM often has higher deductibles than conventional treatments. You may also need to purchase a separate rider to your current insurance in order to get the coverage. Also, even if your insurance does not reimburse for such treatments, it may have a list of CAM providers with whom it has negotiated discounts for members.
"It's easier to get reimbursed for alternative treatments that are used to provide comfort for the patient, such as black cohosh, which some women take to relieve the hot flashes that are caused by the antiestrogen drugs they are taking to treat their breast cancer," says Otis Brawley, MD, chief medical officer at the American Cancer Society. "But when you're talking about herbal treatments directed at the cancer itself, it's very unlikely to get paid for."
Stress, weight loss, and smoking cessation
Insurance companies are increasingly promoting healthy living. If you are diabetic and need to lose weight, your insurer may reimburse part of the cost of a health-club membership, weight-loss regimen, or other program that can help manage your diabetes. If you are suffering from heart disease and are a smoker, your health plan may offer counseling or support programs to help you quit.
"Carriers want people to take better care of themselves because it costs them money when they don't," says Jamie Charlton, a partner and health-benefits specialist at Saxon Financial Consulting in Cincinnati. "So they are promoting benefits such as health coaches, who help you quit smoking or manage stress."