Americans Are Still Paying Out of Pocket for Complementary and Alternative Medicine

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Traditional Chinese Medicine Treatment - Acupuncture

Garlicky chicken soup was once the standard cure for a cold and peppermint was used to soothe an upset stomach rather than going to the drugstore for an over-the-counter pill. Grandma’s remedies have been coming back in a big way: About 59 million Americans spend money out of pocket on complementary health approaches, totaling approximately $30.2 billion a year, according to information provided by the National Center for Complementary and Integrative Health (NCCIH)—a U.S. government agency housed under the National Institutes of Health that explores integrative and alternative medicine.

Complementary (also called integrative) medicine is when a non-mainstream practice is used in conjunction with conventional medicine. Alternative medicine uses non-mainstream practices in place of conventional medicine. They’re often referred to together as Complementary and Alternative Medicine (CAM) and have a similar objective: to find and treat the underlying causes of health problems rather than to just address symptoms.

CAM practitioners use holistic and preventive approaches to relieve and cure ailments ranging from the common cold to inflammatory conditions like arthritis. CAM treatments include herbs, whole foods nutrition and preventive lifestyle habits to support health, such as exercise, avoiding processed foods and smoking, stress management and light or no alcohol use. CAM also includes chiropractic, yoga, meditation, vitamins, minerals and natural anti-inflammatories and antioxidants, as well as ancient healing approaches such as acupuncture. 

Carol Brown is a Doctor of Osteopathic Medicine. She had worked in conventional medicine as a primary care physician before training in integrative methods. Sixteen years ago, she formed her own integrative practice in Oak Creek, Wis., CMB Health Specialties (formerly known as the Center for Integrative Health Care). Brown uses holistic approaches such as nutritional support, specialty lab testing to detect food allergies-sensitivities and hormonal imbalances, as well as intravenous nutrition therapy. She uses conventional medicine as appropriate and may refer patients to practitioners of alternative services, such as acupuncture or massage, or to conventional medicine physicians.

“Integrative medicine gets back to physiology; how does the body work, and what do we need to do to make it work?” Brown says. “It’s about nutrition, supplying what the body needs and looking for underlying causes. If someone has a headache, there are pills for headaches, but we look to find out why they have a headache. It could be gluten intolerance, not enough sleep or any number of underlying issues.”

Brown notes there is a population of people that are not helped by everyday medicine and are driven to seek care outside of conventional approaches. “They’re looking for some other way to help themselves. There’s also a population of older patients who know how medicine used to be, where there was more time to get to the bottom of one’s health. Younger people are suspicious, because everyday medicine has become so commercialized. A lot of people are afraid to take a drug, and they want to get better without meds if that is possible,” she says.

Naturopathic Approaches and Licensing-Oversight

Sarah Axtell is a naturopathic doctor and founder of Lakeside Natural Medicine in Shorewood, Wis. A licensed naturopathic doctor is a primary care physician who is trained to diagnose and prescribe, as opposed to “traditional” naturopath who can do neither.

She also sees a growing demand for CAM approaches. “With a shortage of primary care doctors, exponentially escalating health care costs, epidemics of lifestyle-related chronic disease and obesity and increasing dissatisfaction with conventional medicine, naturopathic doctors are a valuable solution in light of these critical shortages,” she says.

Naturopathic approaches emphasize direct care, prevention, wellness and health promotion. Axtell has a doctorate in naturopathic medicine from the National University of Natural Medicine and is board certified by the North American Board of Naturopathic Examiners. She’s currently licensed as a primary care physician in the state of Oregon—one of 22 states that has licensing or registration laws for naturopathic doctors.

Axtell notes that a licensed naturopathic doctor attends a four-year, in-residence, graduate-level naturopathic medical school; studies conventional, holistic and nontoxic approaches to therapy; is educated in the identical basic sciences as an M.D. or D.O. (Doctor of Medicine or Doctor of Osteopathic Medicine); has three years supervised clinical training as part of medical school; and takes rigorous, national, professional board exams. She’s one of many licensed naturopathic doctors in the state advocating for naturopathic licensure in Wisconsin.

“We are gaining momentum here in Wisconsin and hope to gain licensure in the near future,” Axtell says. “The Wisconsin Naturopathic Doctors Association has generated great support from both Democrats and Republicans in both houses of the legislature. They have worked hard to educate legislators on the importance of licensure for NDs. When legislators fully grasp the positive impact naturopathic medicine has on the health of Wisconsinites, legislators in turn support licensure, which will increase access to and ensure safe delivery care by highly trained natural medical providers.” The Association hopes to see a licensure bill introduced in the 2021 session.

The Wisconsin Department of Safety and Professional Services is the state agency that licenses medical professionals, including M.D.s, D.O.s, nurse practitioners and dieticians. They also license professionals practicing alternative medicine modalities such as chiropractic, acupuncture and massage. There’s currently no state licensing required to practice alternative therapies like aromatherapy, biofeedback, herbalism or nutrition counseling-coaching. Training in those methods often range from self-study to certification through trade organizations or associations that offer online distance learning to in-person classes and workshops that issue certification.

Research and Insurance Coverage

It’s easy to get lost on the internet when researching the efficacy of CAM therapies, and like any topic, there are articles that both support and criticize it. The NCCIH was established with a focus to conduct and support research and provide information about complementary health products and practices. Brown likes to refer people to PubMed, a comprehensive database of scientific and medical journals documenting peer-reviewed studies, many of which have researched CAM topics.

“There’s actually a ton of research out there,” Brown says, and she points to the Cleveland Clinic’s Integrative and Lifestyle Medicine Department as an example of a big hospital system that has implemented CAM approaches. She notes that countries such as Germany, Sweden, Italy and Japan have done advanced research on CAM therapies, but here in the U.S., drug companies have the deep pockets to fund a myriad of large-scale studies that dwarf non-profitable natural approaches. But some of the strongest proof that CAM therapies work has come from its users. “The evidence of getting better is proof enough,” Brown affirms.

Most major health insurance plans don’t cover CAM therapies and are quick to deem them as “experimental” or not “medically necessary.” Some cover CAM therapies such as chiropractic care with restrictions or co-pays or include CAM in flex spending accounts (people are advised to first check with their insurance companies to find out what services are covered). Most practices offering integrative or naturopathic care—or services considered “alternative,” like acupuncture, massage or nutrition counseling—do not accept insurance and are private pay, which can be a prohibitive cost for some people.

But some alternative medicine providers are striving to make their services more affordable. Milwaukee Community Acupuncture is a 501(c)(3) nonprofit offering acupuncture on a pay-what-you-can model, with a sliding scale from $20 to $50 per visit. Amy Severinsen is a licensed acupuncturist who co-founded Milwaukee Community Acupuncture with Oliva Crane. Severinsen realized the need for affordable acupuncture after she visited China and toured acupuncture clinics and saw how affordable it was for people there, so people came in more frequently.

“Previously, I had a private practice, and people responded really well, but because they were paying out of pocket, they couldn’t afford to keep coming in,” she says. Acupuncture works best when a patient receives a series of treatments. Because one doesn’t have to disrobe while receiving an acupuncture treatment, Milwaukee Community Acupuncture’s professionals can see more than one person per hour in a group setting, making their community model cost-effective. The COVID-19 pandemic has forced them to alter their business to see fewer patients in the treatment room at one time; check the website for COVID-19 safety precuations.

Severinsen believes most insurance companies don’t cover alternative therapies such as acupuncture because stronger studies are needed to support its effectiveness. “Once they see those results, I think they will offer to cover more,” she says. “I also think it’s difficult to plug acupuncture into the system of coding and diagnosis, because it’s a different way of diagnosing people and looking at the body.”

Sheila Julson is a freelance writer who enjoys capturing the stories behind Milwaukee’s happening food, beverage and urban farming scenes. She also pens articles about holistic health, green living, sustainability and human-interest features.