HMO and Acupuncture Benefits Information

Until the late 1990s, Health Maintenance Organization (HMO) coverage and acupuncture benefits caused controversial discussions. Prior to the '90s, the medical community regarded as experimental and alternative. Mounting scientific evidence pointed to the benefits of acupuncture for pain management, nausea and headaches. As customers began demanding these benefits, HMOs began to respond.

History

• Traditional Western treatment

  Acupuncture -- a type of traditional Chinese medicine (TCM) that the U.S. system categorizes as complementary and alternative medicine (CAM) -- dates back thousands of years. In 1971, during a trip President Nixon took to China, a "New York Times" reporter traveling with him, James Reston, underwent an emergency appendectomy. Doctors used acupuncture as the only anesthesia during his surgery, which led to a flurry of research and studies in the United States into the medical legitimacy and benefits of acupuncture.

Controversy

• The investigation of acupuncture in the U.S. in the early '70s did not produce the evidence required for acceptance by the medical community. The first acupuncture clinic opened in 1972 in Washington and became popular. The medical community attempted unsuccessfully to shut the clinic down. It took until the '90s and more modern testing abilities to produce the scientific evidence the medical community required. In March 1996, the Food and Drug Administration changed the status of acupuncture needles from experimental devices to medical tools, thus opening the way for coverage under health insurance policies. In 1997, the National Institutes of Health (NIH) released a statement about the safety and effectiveness of acupuncture for various health conditions.

Coverage

• Some HMOs offer alternative care in response to employer and consumer demand.

  In late 1997, American Specialty Health Network became the nation's first HMO to offer acupuncture coverage in California. Other states, including Arizona, Michigan, Nebraska and South Carolina, followed with coverage.

Surveys

• In 1997, Landmark Healthcare commissioned a survey of HMO use of CAM therapies. The company surveyed 114 HMOs between November 1998 and January 1999. Some 31 percent of the HMOs surveyed offered acupuncture. In 1999 a study examining insurance coverage of CAM services was conducted in New York, New Jersey and Connecticut. Nearly 40 percent of the insurance carriers covered acupuncture (17 of 43).