title: Insurance Reimbursement for Complementary Healthcare Services.
abstract: BACKGROUND
  Insurance reimbursement for clinical services provided by complementary healthcare professionals in the United States likely differs by provider specialty. It is hypothesized that a lower likelihood of insurance reimbursement demonstrates that complementary healthcare services are not utilized to an optimal level and are not financially accessible to all who may need or want these services. The purpose of this project was to evaluate the likelihood of insurance reimbursement for complementary healthcare services compared with other complementary services and with conventional primary care medical services in New Hampshire.
  
  
  METHODS
  The authors studied health claims for services provided in a nonemergent outpatient setting in New Hampshire in 2014. The study population consisted of New Hampshire residents aged 18-99 years with claims for selected clinical services commonly provided by complementary healthcare providers. The authors modeled the proportion of reimbursed claims by specialty of complementary healthcare service provider, compared with the reimbursement rate for primary care physicians' claims. The authors modeled first for the proportion of reimbursement for any selected clinical service, next for any evaluation and management (E&M) service, and finally for the most commonly used E&M procedure code, current procedural terminology (CPT) 99213 (reevaluation of established patient).
  
  
  RESULTS
  Compared with primary care physicians, the likelihood of reimbursement for any service was 69% lower for acupuncturists, 71% lower for doctors of chiropractic medicine, and 62% lower for doctors of naturopathic medicine. For any E&M service, likelihood of reimbursement was 69% lower for acupuncturists, 78% lower for doctors of chiropractic medicine, and 60% lower for doctors of naturopathic medicine. With further restriction to CPT 99213 only, likelihood of reimbursement was 34% lower for acupuncturists, 77% lower for doctors of chiropractic medicine, and 60% lower for doctors of naturopathic medicine.
  
  
  CONCLUSIONS
  In New Hampshire, the likelihood of health insurance reimbursement for certain clinical services differs significantly by provider specialty. More research is needed to evaluate the extent and cause of such differences and the effect of such differences on the utilization of complementary healthcare services in the United States.
authors.affiliation: 1 Health Services Research, University Health System, Southern California University of Health Sciences , Whittier, CA.
authors.forename: James
authors.initials: J
authors.lastname: Whedon
authors.affiliation: 2 Biomedical Data Science, Geisel School of Medicine, Dartmouth College , Hanover, NH.
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.affiliation: 3 College of Science and Integrative Health, Southern California University of Health Sciences , Whittier, CA.
authors.forename: Anupama
authors.initials: A
authors.lastname: Kizhakkeveettil
authors.affiliation: 4 University Health System, Southern California University of Health Sciences , Whittier, CA.
authors.forename: Melissa Nagare
authors.initials: MN
authors.lastname: Kimura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000529:Complementary Therapies / Q000191:economics / Q000706:statistics & numerical data; D006291:Health Policy; D054625:Healthcare Disparities; D006801:Humans; D007349:Insurance, Health, Reimbursement; D055048:Integrative Medicine; D008875:Middle Aged; D009513:New Hampshire; D055815:Young Adult
keywords: complementary healthcare; health disparities; health insurance; health policy; integrative healthcare