Updated: Aug 20
Integrative medicine, like the approach we use at The Med Spa at Clinical Edge, is the practice of medicine that integrates complementary alternative medicine (CAM) with main stream or "western medicine". Some common CAM modalities include: manual therapies, alternative medicinal systems, traditional Asian medical systems and mind-body therapies. This approach does not just target the obvious symptoms but rather the underlying problems that may be associated with those symptoms the client is experiencing.
Who uses CAM? It probably won't surprise you that in a large logistic regression analysis study by Kemppainen et al., 2018, individuals with difficult to diagnose health conditions were more inclined to utilize CAM. The study also showed that lower income was limited to the use of mind-body therapies, whereas the other three CAM modalities were associated with higher income due to costs of these alternative therapies. Furthermore, CAM use was more common among women and those with a higher education. Why you ask? Well in my opinion we just don't take "no" for an answer.
If CAM is so widely accepted, why doesn't basic health insurance pay for some of these approaches? Before jumping on the soap box of lack of monetary support for the evidence required for the FDA approval of some of these modalities let me give you an example of why you DON'T want your insurance paying for alternative therapies. The truth is that the process of turning a natural resource to a western medicine doesn't always improve the original medicinal effect, nor is it possible to bottle up most of these modalities. Furthermore, the process of synthesizing these molecules into drugs costs billions of dollars from testing to market resulting in a product untouchable by most Americans. This is where your insurance company can be helpful - if you make the "cut". In other words, if the drug is on formulary and if you qualify you may be eligible to pay only a portion of the cost under your pharmaceutical benefit. No thank you, I'd rather have the option to make the decision for myself and at a more affordable price.
Most people misunderstand what health insurance really is. However, homeowners’ insurance and car insurance seem to be very well understood. It's generally perceived that insurance is for a disaster like a hailstorm that comes once every ten years, or like the car accident you hope to never get into. However, when it comes to health insurance people assume everything related to keeping them healthy is covered. When in fact they are dead wrong (no pun intended). In fact, it is more cost effective to pay out of pocket for your preventative medicine that should logically include CAM since western medicine alone is used to treat conditions, not prevent them.
This may explain why so many providers (Dewey, 2015; Gonzalez & Reporter, 2014; Meg Wingerter, 2023), especially integrative practitioners, are moving to the direct model pay method. In fact, over 53% of primary care doctors admit to having considered moving toward this type of model rather then billing insurance providers who often dictate the plan of care. Even patients report a higher satisfaction rate with providers who use the model because of the transparent fee schedules and ability to be seen sooner rather than waiting for referral's and approvals. In fact, clients feel empowered when partnering with a direct pay provider who is willing to offer you more than just a pharmaceutical script.
Direct pay means that when you see your practitioner, you pay them directly. If you have an “out of network benefit” with your health insurance company, you may be eligible for reimbursement under this benefit. Rather than the doctor billing the insurance company directly you would be responsible for sending in your paid invoice with the medical codes. Regardless of you having an out of network benifit or not, if the care provided does not meet the insurance companies’ criteria the bill may be denied. It simply comes down to what kind of approach to your health do you want to take, one dictated by others, or one dictated by yourself.
Some of the common CAM approaches used at The Med Spa at Clinical Edge includes extensive Thorne testing, bio-identical hormone replacement (BHRT), protein rich fibrin and platelet injections (PRF and PRP), laser and other rejuvenating technologies. We strive to provide a holistic approach to the well-being of our clients while delivering premier skin rejuvenation services to help our clients achieve their youthful selves.
Dewey, C. (2015). Direct-pay medicine presents alternative health care model. Grand Rapids: Gemini Publications.
Gonzalez, J., & Reporter. (2014). New law lets doctors drop insurance model for direct pay. New Orleans CityBusiness, Retrieved from https://search.proquest.com/docview/1558919870
KEMPPAINEN, L. M., KEMPPAINEN, T. T., REIPPAINEN, J. A., SALMENNIEMI, S. T., & VUOLANTO, P. H. (2018). Use of complementary and alternative medicine in europe. Scandinavian Journal of Public Health, 46(4), 448-455. doi:10.1177/1403494817733869
Meg Wingerter. (2023, Jan 13,). More colorado primary care doctors are opting out of insurance as direct-pay model grows. The Denver Post Retrieved from https://global.factiva.com/en/du/article.asp?accessionno=DNVR000020230113ej1d0003q