Zion Health and Alternative Medicine: What You Need to Know

What is alternative medicine?

There are many different types of alternative medicine. In general, the term alternative medicine refers to medical treatments that are not part of standard (Western) medical care. In some cases, an alternative practice could be as simple as adjusting your diet or practicing yoga and meditation to focus on your holistic health. Other times, cutting-edge medical technology is considered alternative medicine.

Other common examples of alternative medicine include

  • Acupuncture
  • Herbal medicine
  • Massage

Alternative medicine can vary widely in its legitimacy and effectiveness. Most insurance companies will not cover these practices, citing insufficient evidence to demonstrate effectiveness, even when these treatments are recommended by a licensed provider and have a long history of effective use.

Does Zion Health share in alternative medicine?

At Zion Health, we want to give our members the freedom to get the care they need. But we also want to make sure that we share our members’ contributions for treatments that have been tested and proven to be safe and effective.

Our Medical Director keeps up with the latest medical research as well as cutting edge treatments and those that are not “mainstream” but are cost effective and beneficial to our members. He helps our team determine whether a certain alternative treatment should be shared using the community’s contributions and based on our published Member Guidelines. Eligibility determination for alternative medicine is made on a case-by-case basis, taking in the individual circumstances of each member into account.

For example, Zion Health recently shared in laser therapy for a musculoskeletal condition.

Laser therapy (also called low-level laser therapy, or LLLT) has been used for over 40 years, and many studies have shown this  therapy to be effective in reducing inflammation and promoting healing for a variety of musculoskeletal conditions. It is often used to help reduce chronic pain associated with various musculoskeletal diseases.

While most insurance companies would not cover this treatment, our members have benefitted from Zion Health’s openness to new methods of treatment and our dedication to keeping up with the latest medical technology.

What do I do if I’m considering an alternative treatment?

Zion Health requires you to obtain prior written approval before we will share in any alternative medical treatment. Here are some of the basic requirements:

  • The treatment must be provided by a licensed care provider.
  • The treatment must be “medically necessary,” which generally means that it was recommended by a doctor or licensed care professional.
  • The treatment must have sufficient research to show it is safe and effective.

Once you have determined whether or not your alternative treatment fits these criteria, you should submit an alternative need request. The need request submission form will ask you for the following information:

  • Explanation of why the alternative medical need was selected
  • Explanation of why the alternative medical need should be shared
  • Doctor notes on current condition (Zion Health can help obtain doctor notes)
  • Estimated costs (Zion Health can help obtain the estimated costs, if appropriate)

Once the request is submitted, Zion Health will evaluate your need for sharing. Determinations are made on a case-by-case basis since the medical conditions and the treatments can be so varied and usually do not fall within a specific Member Guideline.

Zion Health is always investigating safe. low-cost treatment options for our members, and we are proud to offer alternative treatment sharing.