Health insurance coverage for holistic stroke recovery?
September 9, 2014 6:12 AM   Subscribe

I'm seeking recommendations for a PPO health plan that would cover an out-of-network MD, an MRI, and many sessions of acupuncture.

Hi AskMeFi,

I live in California and am a female in my late 20s. I have reason to believe that I may have had a mini-stroke over a decade ago, but have regrettably only realized what that experience was in more recent years.

My holistic practitioners and my MD (who I only see as needed) are suggesting an MRI to check for a possible blood clot that has remained in my brain all this time, due to some lingering symptoms of weakness and numbness from head to toe along one side of my body. I don't have any health insurance now, and no diagnosis. I am otherwise in pretty great health. I already know that my desired course of treatment will be alternative medicine (acupuncture).

I'm looking for a PPO health plan that will cover:
a) 1-2 visits to my out-of-any-network holistic MD
b) 1 MRI (and possibly a qualifying visit to a Neurologist)
c) many sessions of acupuncture over a year or more with a stroke recovery specialist that takes PPO plans that cover acupuncture

I have tried some searches but have no idea what I'm doing.
What does AskMeFi suggest? Would paying out of pocket make the most sense for my desired path of treatment?

- In The DARK (Dignified Acceptance of Regrettable Karma)
posted by anonymous to Health & Fitness (5 answers total)
After ten years, it's not still the original clot... it would be damaged brain (or a new clot.) If that is what you had. Acupuncture cannot heal brain injury and it's value is still to be determined.

I believe you need to further seek clarification from your gp.
posted by taff at 7:22 AM on September 9, 2014 [1 favorite]

If you are looking to sign up for an individual plan, be aware that open enrollment doesn't start for a few months and will not cover you until January.

The Affordable Care Act requires that all individual insurance plans cover acupuncture.

The MRI is only going to be covered if a doctor can convince the insurance company it's necessary. Given that your MD is suggesting it, I would assume that would be ok, if the neurologist also ok's it.
posted by jaguar at 7:22 AM on September 9, 2014 [1 favorite]

Just to clarify, if you had a stroke, you had a stroke. A mini-stroke, also known as a trans-ischemic attack or TIA, by definition, has no long term symptoms. It's possible that you had a small stroke, but I wouldn't use the term mini-stroke because it has a specific medical meaning.

Now then, if indeed you did have a stroke ten years ago, and if indeed it was caused by a blood clot, the clot is gone by now. They would be looking for the damaged area of your brain.

Good luck to you.
posted by brevator at 6:41 PM on September 9, 2014

You can get an MRI coveted by any medical plan as long as it is needed. As you have a medical professional backing you up it will probably be reccomended.

Not many plans will cover acupuncture long term as it isn't an evidence based practice. Sometimes I've seen it covered for pain management reasons but that's about it. You may be able to get student acupuncture in your area for cheaper.

With a PPO your Co pay will be higher or a percentage of the bill. They will recommend you stay in network so looking for a neurologist in network to get the MRI would be wise.
posted by AlexiaSky at 7:28 PM on September 9, 2014

In terms of just paying out of pocket: if you've had a stroke you really do need health insurance long term. They may want to put you on medication such as a blood thinner. You may need to see doctors more regularly. Having a stroke increases your chances of having another one and a PPO would cover any subsequent hospitalizations. In addition if you have some sort of brain damage insurance can cover physical therapy or a Psychologist who specializes in brain damage (I can't remember their exact title) who can walk you through adaptive strategies to help increase your quality of life and track decline or improvement in areas of functioning. If you can afford insurance there is really no reason for you not to find some sort of plan. Even if it's to cover major things and you just self pay for your out of network MD. You can get a In network MD you go to and let him know that your out of network wants whatever major tests (it will help to bring medical records) and get then ordered in network.
posted by AlexiaSky at 7:35 PM on September 9, 2014

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