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Complementary Medicine - the view from a health insurer

by Peter Fermoy(more info)

listed in insurance, originally published in issue 22 - September 1997

Increasingly, organisations such as BUPA are recognising the wider acceptance of complementary techniques. BUPA itself has always been keen to support changes in medical practice which improve the treatments available to its members.We are keen also to make available to our members a range of services and treatments to suit their health care needs.

Availability and access to complementary therapies through insurance cover will become improved and increased in future months and years. BUPA, for instance, is already considering a move early next year (this article first published 1997) to permit patient referral to a comple- mentary therapist direct from the general practitioner.

Nevertheless, and from whichever source the referral is made, BUPA has an obligation to its members to ensure that treatments they receive are appropriate and to the benefit of their health.

Therefore, the qualification and, subsequently, insurance eligibility of the person providing the complementary medical treatment remains for the present a key factor in determining whether a claim for complementary medicine is eligible.

Appropriate qualification

At present, in some areas of complementary medicine there is only limited control over the training of practitioners. Therefore, BUPA's policy must be designed to ensure our members are treated by appropriately qualified practitioners.

Our rules regarding eligibility for medical insurance cover therefore have to reflect this, but they do not discount the potential for our members to receive treatment from a complementary therapist.

BUPA would consider the payment of benefit towards the cost of complementary medicine, on an out-patient basis, provided:

* the practitioner providing the treatment is eligible for benefit

* the condition requiring treatment would normally require treatment by a consultant and could not be provided by the patient's general practitioner

* the claim is otherwise eligible for benefit and in particular, fulfils BUPA's definition of eligible treatment, ie. an acute illness or injury or an acute episode of illness or injury

* the particular area of complementary medicine has gained acceptance within the UK as an appropriate treatment. While the main streams of complementary medicine have gained a reasonable level of acceptance within the wider medical profession in the UK, there are some areas where this is not the case (eg. transcendental meditation). If requests are received for treatment by any complementary therapist, they should be referred to BUPA for confirmation, before any treatment takes place, and it must be under the control of a recognised consultant.

Provision in rules

Whilst the main purpose of BUPA benefits is to provide cover for treatment by consultants and therapists, there is provision in BUPA's rules for treatment to be provided by what it terms 'other practitioners'.

This enables consultants to have the clinical freedom to use the services of other therapists as appropriate within a course of treatment.

This means that BUPA will reimburse for treatment if it meets the following conditions:

* a consultant has referred a patient to a complementary practitioner before any of the services were provided

* all the services are provided as an essential part of an overall course of treatment given to you personally by that consultant.

On the whole, most practitioners of complementary medicine do not have a medical qualification and are not, therefore, eligible in their own right, as they do not fulfil BUPA's definition of an eligible consultant.

This does not mean that BUPA will not recognise any complementary therapist.

BUPA's rules make provision for complementary practitioners to be recognised as 'other practitioners' as described above, or in exceptional circumstances as 'special eligible providers'.

Special status

The awarding of 'special eligible provider' status by BUPA is completely discretionary but based on certain criteria.

For acupuncture, osteopathy, chiropractic and homoeopathy, the following criteria are used to consider to grant discretionary recognition:

* registered medical practitioner with post-graduate qualification in their field of complementary medicine

* practised solely in their field of complementary medicine for a minimum of four years

* references from two medically qualified consultants

* must only treat patients referred by a GP or medical consultant.

Other factors to support application for special eligible provider status would include the practitioner having published scientific papers in their field of complementary medicine, holding an NHS post which entails the use of and/or the holding of a teaching post in the area of complementary medicine.

So, as you can tell, the medical insurers have begun to take a more open approach to complementary therapies. And as time goes on and wider medical acceptance grows we may see more and more complementary therapy reimbursed by insurers.

For its part, BUPA is actively reviewing its policy and intends to open discussions with a number of the appropriate representative bodies.

Not questioning validity

On the whole, BUPA does not question the validity of complementary therapies: our main concern is that the person providing the treatment is appropriately qualified.

BUPA is in a unique position among independent health care companies in the UK as both a purchaser and provider of health care.

BUPA owns 29 hospitals in the UK, which are open to all – not just members of BUPA health insurance schemes. People insured with other companies are eligible to use the hospitals, as are individuals funding their own treatment.

Some BUPA hospitals offer some complementary therapies, whilst one, in Bushey, Hertfordshire, is currently undertaking a pilot study into the potential of offering a range of therapies at the hospital. The services are available to people who wish to fund their own treatment.

Credible service

Complementary therapies available under the pilot scheme include aromatherapy, reflexology, osteopathy, stress management and Alexander Technique. BUPA's aim is to provide a credible complementary service, with appropriately recruited and managed practitioners.

BUPA Hospital Bushey is an ideal site for the pilot as a large number of qualified, experienced therapists practise in the area.

Only the leading therapists in each of the chosen specialities will be available to patients. The therapists work to a code of practice and are members of a recognised professional association.

Further Information

For further information, please contact Peter Fermoy, Public Relations Officer, BUPA, Tel: 0171–656 2087.

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About Peter Fermoy

For further information, please contact Peter Fermoy, Public Relations Officer, BUPA, Tel: 0171–656 2087.

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