For all of ACA’s faults, such as mandating high minimum coverage akin to having a $250 deductible for auto insurance that makes you pay the highest possible premiums, one of the benefits of it was giving more recognition to alternative medicine. Let’s take a look at how the Affordable Care Act has improved patient access to alternative medicine.
The Law Itself
The Affordable Care Act itself states that health insurers must reimburse healthcare providers for essential care. Section 2706 of the ACA states that insurance providers shall not discriminate against any health provider with a valid state license, whether a naturopathic healer or conventional medical professional. This opens the door to patients receiving insurance coverage for essential care from licensed alternative care practitioners.
Limits of the Law
The first limit of the law is licensing. This means that a health insurer cannot refuse to pay a chiropractor or other licensed medical care practitioner when the care is otherwise covered by the health insurance plan. You can still buy what you want as long as it is otherwise legal, but your health plan doesn’t have to cover all or part of the cost.
The rules for licensure and insurance care vary, too, from state to state. If an alternative medical care practitioner isn’t licensed in your state, the insurer does not have to pay them for their care or reimburse the patient. A massage therapist’s services may be reimbursed if prescribed by a doctor, whether or not the therapist is otherwise covered by your health plan. In this case, it is the doctor’s recommendation that drives the insurance plan to pay for it. A common case for those with a health care law degree is filing challenges with health insurers to get reimbursement.
The Definition of Essential Care
Essential care is the second standard for reimbursement by insurance companies under Obamacare. Essential care includes maternity care, mental health and addiction treatment, prescription drugs, rehabilitation, laboratory services, wellness services and chronic disease management, oral and vision care for children. A midwife, whether licensed or not, is probably going to be reimbursed for delivering a baby since that is one of ten categories of essential care. If you’re seeing an aromatherapist or life coach, it is almost never covered unless they have a medical license or counseling certification. Programs like the Hofstra Law health law degree are preparing graduates to develop and get approval for state licenses for these professions.
Wellness and chronic disease management parameters vary from state to state. Can you take herbs like garlic supplements to manage high blood pressure? If your doctor prescribes it, your health plan probably has to cover it. Going to a compounding pharmacist to mix your prescription drugs into a paste or liquid form you can swallow is likely covered if that person is licensed by your state. Having flavoring or other herbs mixed in is an extra cost that is considered non-essential, so it doesn’t have to be covered.
The ACA changed the legal landscape for alternative healthcare and did much to legitimize it. Health insurers have to reimburse essential care from licensed medical professionals. Essential care varies state to state, which has complicated issues for insurers and increases the demand for health law professionals.