Beyond Medical Expenses
How nice would it be if your health insurance covered items that went beyond conventional treatments? For example, getting a massage would be included because it helped to keep you healthy. Well, that day may not be far off as some health insurance companies are beginning to pay for medical expenses that have not been covered before.
Health insurance continues to evolve beyond its beginning when insurance only paid for hospital stays in the early part of the 20th century. Doctor visits and prescription medicines were eventually added. In the last few decades, many plans added chiropractor care, which was a big nod to the benefits of alternative medicine.
Recently though, a few insurance companies have started to take even bigger leaps with coverage that may at first glance look like the coverage has nothing to do with medicine. For instance, what if you needed your house cleaned after a hospital stay?
Several medical insurance companies are paying for services that move beyond covering expenses once you are sick to items that keep you healthy or prevent relapses after a significant illness. Rides to the gym, delivery of fresh meals, and visits from healthcare workers to get to know patients are just a few of the new offerings from some insurance companies.
How insurance pays medical providers is the part of the driving force behind the additional benefits. In the past, doctors and hospitals were reimbursed for each service they provided which limited what doctors could provide. Now, the move is to focus on overall patient health. Insurance companies in the last few years realized that health care costs are lower when services are made available that help their insured be healthy.
Also, contributing to the change was a study in 2016 by the American Journal of Preventive Medicine. It showed that income, diet, and other lifestyle factors were more instrumental in driving a person’s health than access to health care. Access to health care had only a 20 percent influence on health. While it’s expensive to provide some of the benefits, experts say in the long run it’s less costly to prevent a heart attack than cure one.
“For many people, taking care of their blood pressure or their diabetes is not particularly high on their list when they don’t know where their next meal is coming from,” said Dr. Lori Tishler, vice president of medical affairs with the nonprofit insurer Commonwealth Care Alliance.[i]
This approach is especially beneficial for those with low income and those with chronic illnesses who for various reasons may not be able to follow a doctor’s recommendations or may become isolated. For example, part of the new health insurance paradigm is to also keep patients connected socially, which has shown to improve health outcomes. Anthem insurance company started a program called “Togetherness” where a care manager regularly checks in with patients with chronic conditions.
“The U.S. health care system must be redesigned to get away from the idea that more health care equals better health, said Dr. Sanne Magnan, a senior fellow at the think tank HealthPartners Institute. ‘We’re spending all this money, but we’re not getting good results….'”[ii]
The thinking is that patients who are socially involved are more engaged in their health. For Virta Woodard of Long Beach, California, who has diabetes and chronic pain, connecting with her care manager and getting rides to her fitness classes has helped her to lose 34 pounds.
Other assistance included sending a social worker to help a recovering stroke victim to help sort through bills, check in with her, and arrange for house cleaning. Overwhelmed at the beginning of her healing process, Sharon Romano said the help gave her hope. Other programs deliver healthy meals designed to meet the dietary needs of the chronically or severely ill.
Keeping people healthy is the philosophy of complementary and alternative medicine (CAM), such as Ayurveda, Naturopathic Medicine, and Traditional Chinese Medicine. With at least 30 percent of U.S adults having used CAM therapies, hopefully, healthcare insurers will expand their vision of keeping their insured healthy by covering more of these services.
Accidents Of History Created U.S. Health System (October 22, 2009). Retrieved from https://www.npr.org/templates/story/story.php?storyId=114045132.
Complementary, Alternative, or Integrative Health: What’s In a Name? Retrieved from https://nccih.nih.gov/health/integrative-health.
Health Care Industry Branches Into Fresh Meals, Rides to Gym (July 23, 2018). Retrieved from https://apnews.com/b694e37ea86c4a8c923e18343129d113
[i] Health Care Industry Branches Into Fresh Meals, Rides to Gym, July 23, 2018. Web.