State Requires Coverage Of Holistic Care New Law Would Make Insurers Pay For Alternative Medicine
Health insurance is going holistic.
Come 1996, Washington state law will require that insurers cover naturopathic physicians, acupuncturists, massage therapists, nutritionists and “every category” of licensed health care professional.
The change in law, controversial in the health insurance industry, is unprecedented nationwide. Passed by the 1995 state Legislature as part of the latest revision of state health care reform, it becomes effective Jan. 1.
The change is backed enthusiastically by some at the top.
Betty Woods, chief executive officer for Blue Cross of Washington and Alaska, has been going to an acupuncturist since 1992.
“I had been in a car accident,” Woods said. She said her acupuncturist has been most successful in treating pain from a ruptured disc and whiplash. Like most people, Woods has had to pay for these services out of her own pocket.
State Insurance Commissioner Deborah Senn goes to an acupuncturist, a naturopathic physician and others who provide alternative therapies.
Senn said her interest in such therapies derives from her conscious effort to improve and maintain good health. She even drinks a no-caffiene, non-dairy substitute for espresso, a soy Postum latte, something her husband calls a “dirt latte.”
Senn and Woods are not alone, given that more than one in three people use some form of alternative medicine. And like these two, most have had to pay on their own for such services because insurers typically don’t.
When the 1995 Legislature greatly scaled-down the health care reform law passed in 1993, it preserved one aspect intended to protect and enhance consumer choice in health care, including choice of so-called alternative therapies.
“It’s going to be a good thing for alternative medicine,” said Dr. Joe Pizzorno, president of Seattle-based Bastyr University, the nation’s leading teaching institution in naturopathy and natural medicine.
Predicted Woods: “It will be a little confusing at first.”
Woods agreed with some critics who contend the law is vague. But she said Blue Cross’ experience with a pilot program called Alternapath, which last year offered separate insurance for certain alternative therapies, demonstrated market demand for such coverage.
Woods said Blue Cross intends to start a refined version of Alternapath sometime early next year.
The law does not specify which categories of health care professional must be covered. But it has been interpreted by the state Office of the Insurance Commissioner to include the more than 30 health care professions licensed by the state.
Insurers won’t have to begin paying for any alternative medical care until existing insurance policies come up for renewal during 1996. When that happens, alternative services will be covered on the same basis as any traditional medical care.
For example, an office visit to a naturopathic doctor will be reimbursed in the same way each health plan now pays for a visit to an M.D.; and payment for a service will hinge on whether that service - be it bee pollen or therapeutic massage - is provided for a condition or illness already covered by the policy.
In short, don’t expect Blue Cross or King County Medical to cover aromatherapy for hair loss. But do expect coverage if you see a naturopath for your allergies.
Dr. Simeon Rubenstein, Group Health Cooperative’s director of corporate medicine, is not enthusiastic about the reform.
One in every seven residents of Washington state is without health insurance, Rubenstein said, and now there is a new law guaranteeing those with coverage paid access to their acupuncturist, naturopath or homeopath.
“What’s more important here?” he asked.
The new law is difficult to incorporate into existing insurance schemes, Rubenstein said. Naturopaths, he said, are philosophically disinclined to provide insurers with a precise list of services to be covered because they emphasize treatment as tailored to fit the individual.
“It’s like a greased pig,” he said. “You can’t get your hands around it.”
Dr. Bruce Milliman, a Seattle naturopath and president of the Washington Association of Naturopathic Physicians, acknowledged Rubenstein’s concern. But Milliman said much of traditional medicine is done without proven effectiveness or value.
“This isn’t just a problem for alternative medicine,” he said.
Rubenstein agreed, but said the solution is to make all therapies and health care services prove their value. The solution is not, he said, to just implement a vague new law requiring insurers to cover “every category” of health care provider.
But Milliman said a law designating specific services would be cumbersome and would not provide the intended consumer freedom of choice.
The new law, he said, will not force an insurer to cover every provider of every service. Insurers, Milliman said, still will have the authority to select specific licensed health professionals for their health plans.
Naturopathic physicians, licensed in Washington state since 1914, “look at the whole patient,” he said, and treat each person differently. Today’s health insurance system, Milliman said, is based on the traditional medical approach in which a physician is paid according to a body part rather than for treating the patient “in totality.”
“Somehow we have to come up with a way to incorporate that into our reimbursement system,” he said.
xxxx Change in the law The new law will not force an insurer to cover every provider of every service. Insurers still will have the authority to select specific licensed health professionals for their health plans. -Dr. Bruce Milliman, president of the Washington Association of Naturopathic Physicians.