Insurers limit acupuncturePressure to control costs, coupled with doubts
about chronic pain treatments, have led insurers to restrict acupuncture
coverage.

http://www.twincities.com/mld/pioneerpress/news/local/13985945.htm

BY JEREMY OLSONPioneer PressHEALTH

"This is my last resort. The medical community couldn't help me
anymore." Sue Brix, who took a job at East West Clinic, where she
receives free acupuncture as a benefit
Acupuncture allowed Rosemarie Peterson to do little things — like
garden or stir cake batter — but the East Bethel, Minn., woman stopped
receiving treatments last fall when her health plan stopped covering
them.
The arthritic pain in her right arm and shoulder quickly returned, and
chores like vacuuming became painful and exhausting again.
"I just live with it day by day," she said.
Peterson, 78, is among the people suffering chronic pain who couldn't
afford acupuncture after HealthPartners, one of the three largest private
health insurers in Minnesota, reduced its coverage of the alternative
therapy.
Pain management is a growing aspect of health care, and pain
medications are generally covered by insurers. But acupuncture is often
stuck on the outside looking in. HealthPartners may have reduced its
coverage, but other health plans in the state already have restrictions or
don't cover it at all.
Acupuncture involves placement of needles at pressure points in order
to improve the natural flow of electricity through the body. Medical
research offers an uneven view of its benefits when it comes to pain
relief, partly because it is difficult to evaluate through traditional
research techniques. That is one reason why insurers are skeptical
when they set coverage policies, especially given the pressure they face
to control overall health care costs.
HealthPartners switched in July 2005 from unlimited acupuncture visits
to 12 treatments in a lifetime and then a requirement that patients gain
prior authorization from the insurer before receiving any more. The
change occurred after HealthPartners officials found that many people
were using acupuncture for "maintenance" purposes — to keep away
chronic pain.
HealthPartners never intended to cover chronic maintenance, so the
new prior authorization requirement was a way to identify those cases
that weren't supposed to be covered, said Kathy Moline, a supervisor of
medical policy for the Bloomington-based insurer.
This preserved short-term coverage for people needing pain relief after
injuries or seeking to reduce the nausea associated with chemotherapy,
pregnancy or surgery. And it still gave patients needing more than 12
treatments the option to gain approval for more.
"It's never like a dead-end street," Moline said.
HealthPartners reported that it grants 40 percent of requests for
additional treatments and spends nearly $1 million a year on
acupuncture.
But Peterson — whose treatments fit the definition of chronic
maintenance — was denied more treatments. Even a letter from her
doctor didn't help, she said.
Acupuncture treatments are relatively cheap — $40 to $75 each — but
the costs add up, especially for people on limited incomes.
Pain management can be the difference for elderly patients between
independence and assisted living or nursing home care, said S. Colet
Lahoz, a licensed acupuncturist for the East-West Clinic in White Bear
Lake and Roseville. Some patients can't take pain relievers for medical
reasons, she added, so acupuncture is one of their few options.
"(HealthPartners) may call it maintenance," Lahoz said, "but it is the
only thing that works for their chronic pain."
Blue Cross and Blue Shield of Minnesota covers acupuncture for chronic
pain, provided the pain has existed for at least six months and the
patient has tried drugs, physical therapy orpsychotherapy. Treatments
also must be provided or supervised by doctors.
Medica only covers acupuncture performed in medical clinics or
hospitals.
Among public programs, Medicare doesn't cover acupuncture for
seniors and the disabled. The state's Medical Assistance program for
low-income Minnesotans requires prior authorization after 10
treatments for chronic pain, and also requires that doctors perform or
supervise the treatments.
Most insurers didn't cover acupuncture at all 20 years ago, so even
limited coverage is an improvement, said Patricia Culliton, director of
alternative medicine for the doctors' group serving Hennepin County
Medical Center. She also helped in 1997 to develop the National
Institutes of Health consensus statement that validated acupuncture as a
promising therapy that simply needed more study.
"Why an insurance company would limit treatment to 12 visits to
somebody who is showing improvement boggles my mind," she said.
Part of what holds acupuncture back is the inability to test its
effectiveness. In drug tests, one group of patients receives the actual
drug while another group is given non-medicating placebos. (The
placebos are needed to rule out the psychological benefit of simply
taking pills.) The same comparison is difficult in acupuncture.
One method is giving real treatments to one group by inserting the
needles in the proper places and then giving a "sham" treatment to
another group by inserting the needles in the wrong places. This
method is disputed, though, because some experts believe the needles
in the wrong places still have an effect.
Part of the debate for insurers is not about the merits of acupuncture,
but about the pressure to spend health care dollars wisely. Pain
management can help people recover from injuries or accidents and
overcome chronic pain. But it can also be a sinkhole for insurers if
people don't make any progress as a result of their treatments.
Culliton said she believes insurers would save money if they expanded
coverage of acupuncture for chronic pain, because the treatments can
delay or even prevent the need for orthopedic surgeries or other
expensive medical services.
Peterson, the 78-year-old with arthritis, wasn't exactly a believer in
acupuncture, but she needed something for her arthritis, and a kidney
condition limited the drugs she could take.
"I decided to give it a try and by gosh I started feeling better," she
said. "By the time I had to quit, I was really feeling better."
She initially received two treatments a week, but was down to one a
week at the end. She hoped when the coverage stopped that maybe
she wouldn't need them anymore. Now she is saving money and hoping
she can afford to go back.