I was just looking at the list of what is covered and excluded from my Healthcare Flex Spending Account. I get regular massage therapy, mainly for lower back pain but also just for general relaxation. I checked and massage is specifically excluded. Okay, fine—I know that the evidence is scant for its effectiveness in relieving pain, but it works for me. No harm no foul. But then I catch sight of a couple of interesting treatments that are specifically allowed:

Chiropractic—okay, no big surprise. Despite having virtually no clinical evidence to support it, I realize that they have a strong lobby and have managed to get included in most health plans, so this wasn’t a shocker. Although I have tried it and I can tell you that massage has been much more effective for me.

Now for the really good ones that are specifically allowed…

Acupuncture! (Seriously?) ...and…

Christian Science practitioner’s fees! Are they freaking JOKING?

So I can’t get a break for a service that actually helps me but I could go see someone whose “practice” consists of:

Christian Science practitioners provide spiritual treatment through prayer that results in healing—which includes the resolution of relationship or financial difficulties, physical cure, and transformed lives. Treatment is based on the Bible and the principles explained in Science and Health with Key to the Scriptures by Mary Baker Eddy, including the idea that there is one, all-good God, who loves and cares for each of us. Christian Science teachers are active practitioners who are also authorized to teach classes on Christian Science.

That is right off the official website of christian science. How is this not a violation of the establishment clause?

Crazy is right. But re. the Establishment Clause, is your healthcare provided by a private insurer? If so, it wouldn’t fall under that clause since it’s not a government entity.

Though I must say I’m as teed off about the chiropractic and acupuncture as the prayer. In fact, the former two can even be harmful: chiropractic manipulation can cause nerve damage and acupuncture can cause a host of ailments if the needles aren’t prepared correctly.

Massage is another thing, since it is used for pain relief in sports injuries, etc. Though I understand it’s borderline.

Doug, as I understand it, rules for what is allowed and disallowed under the FSA are determined by the IRS. For those unfamiliar, an FSA is a sort of medical savings account. Because contributions are payroll deducted from pre-tax earnings, they result in savings to the employee. It’s also a very convenient way to pay deductibles, co-pays, etc.

I suggest that it might be a constitutional issue with regard to Scientology because of the tax implications and the involvement of the IRS. A do agree that chiropractic and acupuncture are every bit as sketchy as Scientology but at least they don’t (usually) involve religion.

Still, it’s a crazy system that allows such woo while disallowing a practice that stands a much better chance of being effective.

I’m guessing, but from what I’ve noticed in driving around the Los Angeles and Orange county areas, there must be a few thousand “massage” store fronts.  From some news stories, this is the latest gimmick in prostitution.  So, although you have a good reason for it, probably that’s why it’s not allowed as a medical procedure.

Occam

Occam. - 06 August 2012 06:39 PM

I’m guessing, but from what I’ve noticed in driving around the Los Angeles and Orange county areas, there must be a few thousand “massage” store fronts.  From some news stories, this is the latest gimmick in prostitution.  So, although you have a good reason for it, probably that’s why it’s not allowed as a medical procedure.

It’s nothing new, Occam. It’s been well known for years that there are two basic types of “massage.” The kind you are referring to are pretty easy to spot. They are usually advertised as “health spas” even though they are located in seedy strip malls. Often they are staffed exclusively by Asian women, for whatever reason. You see their ads in the newspapers, on the same page as strip clubs.

The legit places are much more low key. They are staffed by state trained, licensed massage therapists, both male & female, and follow strict guidelines. The one I frequent is also a massage school and they offer reduced price sessions with student therapists—and no tipping. (Yeah, I’m a bit of a tightwad!) My only problem with them is they are also into a lot of woo—stuff like aroma therapy and kinesiology—but those are separate programs from the massage.

Like I said, I have found that it helps my lower back pain. But more than that, it is incredibly relaxing and a great way to self-indulge. After a stressful day at the office, an hour on the massage table melts ways the stress.

I’m really not all the surprised or upset that massage is not covered—I’m more upset about the things that are covered that shouldn’t be.

It is sometimes frustrating that decisions about what to include in any regulated insurance or healthcare delivery system are, ultimately, political not scientific decisions. I feel pretty strongly (obviously) that science should inform these decisions and should be the predominant guide to haw we allocate our healthcare resources. Still, I understand other considerations have to be included. The bummer about not being emperor is I don’t always get everything I want from the system, but I understand that reconciling a variety of conflicting views often means making everybody equally unhappy.

There is a common example of strange priorities that I come across every day although it doesn’t involve alternative therapies it does demonstrate that the odd decisions of insurance companies extend to all areas. The odd thing is that when a patient of mine wants to quit smoking I can prescribe something like Chantix which has been shown to significantly improve their chances of success but no insurance company will pay for it even though the cost for a two or three month supply would only be a few hundred dollars and the health saving would be much greater. On the other hand I can prescribe Viagra to the same patient ( which is basically a recreational drug) and they will gladly pay for 4 pills ($20/pill) a month for the rest of that mans life at a cost of thousands. I would love to hear the rationale that went into that decision but I already know how the process goes..Its what the customer wants.

macgyver - 08 August 2012 04:32 PM

There is a common example of strange priorities that I come across every day although it doesn’t involve alternative therapies it does demonstrate that the odd decisions of insurance companies extend to all areas. The odd thing is that when a patient of mine wants to quit smoking I can prescribe something like Chantix which has been shown to significantly improve their chances of success but no insurance company will pay for it even though the cost for a two or three month supply would only be a few hundred dollars and the health saving would be much greater. On the other hand I can prescribe Viagra to the same patient ( which is basically a recreational drug) and they will gladly pay for 4 pills ($20/pill) a month for the rest of that mans life at a cost of thousands. I would love to hear the rationale that went into that decision but I already know how the process goes..Its what the customer wants.

Ya that’s an easy one…the ol’ “follow the money”.  Insurance companies need sick people. Denying medicine so that someone stays sick is just a good business decision. Umpteenth example of why capitalism itself is a disease.

My wife’s insurance was just changed and the new company will only approve a prescription if a dose consists of a single pill.  You can get your Dr. to write separate scripts for different sized dosages of the same medicine which will add up to the same dosage as two pills from the same script and the company will approve them.  Are they just making things complicated on purpose?