Company develops insurance codes for alternative practitioners
When Melinna Giannini's insurance company paid $15,000 for conventional treatments that were ineffective, but not $500 for the alternative treatments that worked, Giannini set about discovering how to make it more possible for alternative treatments to be covered by insurance carriers.

Four years ago Giannini was designing self-funded medical plans for companies when she was stricken with a kidney ailment. Two years later, conventional treatments had not improved her condition. However, after two weeks of treatment through diet, vitamins and herbs from a holistic medical doctor, Giannini's kidney ailment was gone.

Two years ago Giannini decided to investigate how to get alternative medical practices paid for by carriers. The result is Alternative Link, a system that provides codes for massage and body therapies, midwifery, naturopathy, acupuncture, chiropractic and other holistic practices used by medical doctors or doctors of osteopathy.

The reason such codes are needed, Giannini said, is three-fold. First, she explained, insurance policies are designed with data that is generated from codes, and that information is used by underwriters to price health insurance policies. Second, she said, managed care negotiations are based on a price for a procedure, so all claims paid rely on what codes are used. Third, any claim filed for reimbursement needs to be understood by the carrier, and standard codes provide an understandable language, Giannini said.

The codes currently in use by insurance companies were developed by the American Medical Association and were not designed to allow underwriters to understand what it is they are insuring when it comes to alternative therapies, Giannini said. Charges don't always match procedures when alternative practitioners use standard coding, so underwriters have been unwilling to pay claims, and according to Giannini, they need more information. Speaking of massage therapists, Giannini said, "You may do 10 different things [in a session], but you can only give it one code." Alternative Link seeks to change that. Almost 40 codes describe various body work therapies, from manual lymph drainage to Thai massage.

Giannini said that the use of these codes should speed up claims for policies using alternative practices because all the information will be standardized. This has been possible by deciding to include only certain alternative therapies, Giannini said. "We only wanted to describe those therapies with national credentials, quality training standards, associations able to work on behalf of members and [practitioners] able to purchase malpractice insurance."

Development of the codes is essential, said Christine Rosche, author of The Insurance Reimbursement Manual. However, Rosche cautions that the codes only have meaning if massage therapists and body-workers are recognized as health care providers by their state. "What that usually means is licensure by a statewide professional board, not a business license from your city," Rosche said.

Giannini expects it will take some time for the use of the codes to be widespread. Currently the company is in discussion to have six of the 10 alternative medical research projects funded by the Office of Alternative Medicine use the codes. Patent for the codes is pending.