Acupuncture, not pain pills that "make me loopy," is what Cynde Durnford-Branecki wants for her aching back, and a treatment costs her only a $20 copayment.

"If I didn't have insurance, there's no way I could afford to go," said the 51-year-old graphic designer who lives in San Diego.

After years of being lobbied for more choice, insurers and employers increasingly are covering alternative therapies. There are even alternative "HMOs" — networks of nontraditional providers that sell services to big employers and individuals.

It is one of the last frontiers for moving alternative medicine into the mainstream, fans say. Some are pushing to require or expand coverage as part of health care reform.

Choice may sound like a good idea, but it can lead more people to use remedies they may not realize are of unproven value. It also can mean the people who use those treatments will wind up paying for them, rather than have their insurer pay for proven remedies. Here's how:

—Insurers only cover a narrow range of alternative services for specific conditions where there is evidence of value, such as chiropractors for some types of back pain. But these services are marketed for many other uses that lack such proof, such as chiropractic treatments for asthma or ear infections, and acupuncture for high blood pressure or insomnia. Patients can be stuck with the tab, even though the provider is in their insurer's network.

—Most insurers do not pay for herbals and dietary supplements because they are of unproven safety and worth. Yet some insurers, such as Aetna, let sellers advertise supplements to members, which can imply a benefit and coverage. Kaiser Permanente's HMO carries many supplements in its pharmacies and allows its network doctors to "prescribe" ones that it then sells to members, who pay the full cost.

The result: Consumers who choose alternatives can wind up paying a greater share of their health care. Every person who chooses St. John's wort instead of Prozac for depression, red yeast rice instead of Lipitor for lowering cholesterol, or an unproven therapy instead of a visit to a medical doctor, pays out of pocket and saves the insurer money.

Insurers insist that saving money is not their motivation for offering or promoting alternative remedies.

"In no way would it benefit Aetna to have our members using harmful things," said Aetna spokeswoman Wendy Morphew.

Instead, these companies say they are offering the choice that consumers have long demanded, and a safer way to get supplements that people already are buying from sources of dubious quality.

"We're not suggesting you buy this. But if you buy this, here is a place to get it safely," said R. Douglas Metz, a chiropractor who is chief health services officer of American Specialty Health Inc., of San Diego.

It is the largest of about half a dozen firms that provide complementary and alternative medicine services to insurers, employers and individuals. Like an HMO, it has 15,000 chiropractors, 6,000 acupuncturists, 6,000 massage therapists and others in its network.

About 13 million Americans are covered or eligible to use its services, including Durnford-Branecki, who works for the firm.

Aetna became one of its customers two years ago. A recent Aetna newsletter told members they could get at least a 15 percent discount and free shipping on more than 2,400 health and wellness products offered through American Specialty, including vitamin and herbal supplements, aromatherapy products and homeopathic remedies.

"They offered a great program," credentialing providers in their network and finding good supplement suppliers, said Robin Downey, head of product development for Aetna.

"We have members who come to us and ask us for these services. When we can get a discount for them, that's something we are able to pass on," although Aetna also recommends that members talk with their primary doctors about anything they plan to try, she said.

The discount program is "an offering," not a recommendation to use a product, said Dr. Robert McDonough, who develops clinical policies for Aetna.

Metz, of American Specialty Health, said: "We only sell products for which there is no known evidence of risk. Our rule is, if a healthy person can safely take the product we will sell it."

However, he sees great danger in people diagnosing and treating their own ailments, a mindset he described as "I've got a headache and I'm going to go on the Internet and see if there's a dietary supplement that can help me."

Metz also does not use any of these remedies himself.

"The sense that dietary supplements are safe because they're natural is not something that I believe," he said.

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On the Net:

Alternative medicine "HMO": http://www.ashcompanies.com

Kaiser stance: http://xnet.kp.org/permanentejournal/sum08/herbs.html