‘This is a huge milestone’

  • Tue Dec 24th, 2013 12:39pm

By M.L. Dehm <i>For The Herald Business Journal</i>

Roselyn Bailey treats a wide range of patients at her acupuncture and traditional Chinese medicine practice in Everett.

She believes in what she does and she knows the patients who come to her, many paying out-of-pocket for her services, believe in her, too.

Now Bailey is particularly excited about a significant step that she says legitimizes her work.

Beginning this year, insurance companies will be prohibited under the federal Affordable Healthcare Act from discriminating against health care providers such as acupuncturists who are acting within the scope of their professional license and state laws.

“I absolutely think this is a huge milestone, not just for acupuncture but also for the world of integrative medicine,” said Bailey, owner of Arbor Vitae Acupuncture in Everett.

While nothing in the act, otherwise known as Obamacare, actually mentions complementary or alternative medicine, these medical providers have been fighting for these types of non-discrimination laws for years.

More than 38 million adults in the United States make in excess of 300 million visits to acupuncturists, chiropractors, massage therapists, and other complementary and alternative practitioners each year, according to a 2011 survey by Consumer Reports.

Many of these patients and their providers have long sought to get these therapies — commonly known as CAM services — covered by insurance.

Some insurance companies do cover these services; many do not.

That means many patients have had to choose between paying out-of-pocket or restricting their health care to conventional-but-covered services.

While Washington has been at the forefront of recognizing complementary and alternative medicine, the provision in Obamacare is significant, Bailey said.

“It is going to legitimize what has been around for 5,000 years in other countries like China, Japan, Korea and Vietnam,” Bailey said. “In China, they grew up with this kind of medicine.

“When they get sick they don’t even think twice about taking a Chinese herb or going to see a traditional Chinese medicine provider.”

The Affordable Healthcare Act also will help local complementary and alternative medicine practitioners in another way.

Because more people will have insurance through the mandatory health insurance requirement, more people will likely choose alternative medicine.

Michelle Torrance is a licensed naturopathic physician and acupuncturist at Snohomish Naturopathic Clinic in Snohomish. She already has patients awaiting activation of new health insurance policies.

“Just yesterday I had a new patient who had to pay out-of-pocket for her visit but was excited because, starting in 2014, her new insurance plan would cover naturopathic care,” Torrance said. “I think it is very possible that I will see an increase in appointments.”

Bailey has had several calls in the last few weeks from people who would soon add or change coverage. Some have already made appointments for after the New Year when those health care plans take effect.

This portion of the law also demonstrates an important shift in health-care thinking — from a system dominated by the management of disease to one that focuses more attention to prevention, wellness and health promotion, said Jane Guiltinan, a naturopathic physician and the Dean of the School of Naturopathic Medicine at Bastyr University in Kenmore.

Bastyr is a nonprofit, private university that is globally recognized for its graduate programs in natural medicine. These include naturopathic medicine, acupuncture, midwifery, nutrition and more. Bailey herself is a Bastyr graduate.

Who is and is not recognized as a licensed practitioner is something that will have to play out on a state-by state level, Guiltinan said.

Currently all 50 states now license chiropractors, and about 85 percent of states license some kinds of complementary and alternative medicine providers.

“If enforced, this would mean that Bastyr graduates practicing in licensed states should be permitted to participate in insurance plans offered in that state,” said Guiltinan, adding that the law could mean an increase in enrollment if more states recognize Bastyr’s degrees.

The state of Washington actually led the nation in recognizing coverage for these forms of treatment.

In 1996, the state passed a landmark law that required private health insurance companies to cover licensed complementary and alternative medicine providers.

How much coverage depends on the policy.

And, as many insured Washingtonians have found, there are loopholes.

Insurance policies cover only a limited number of these services and those that are covered usually require a primary care doctor’s referral.

“I have a lot of patients who have pushed their doctor to write up a referral,” Bailey said. “Acupuncture is very patient driven.”

While some physicians are open-minded and happy to work with Bailey, others are less enthusiastic and try to discourage alternative therapies.

There is also the in- and out-of-network issue. Bailey is in-network for eight insurance companies but out-of-network for all others.

Some insurance policies have added restrictions on the type of services that are covered. If an insurer in Washington state believes a procedure to be medically unnecessary or not proven to be clinically effective, they have not been forced to cover it.

For example, acupuncture may only be available as treatment for pain management under some policies and not covered for preventative care purposes.

One local insurance company covers conventional tobacco cessation treatments but does not include acupuncture for that purpose although that is a common acupuncture treatment.

The Affordable Health Care Act has its own very large loophole: Medicare does not cover these services and still will not be required to cover them under the new act.

This is something that Bailey finds disturbing as many of the patients that come to her for acupuncture and traditional Chinese medicine are elderly patients on Medicare.

Some these patients are the least able to afford out-of-pocket costs.

Bailey hopes the implementation of the Affordable Care Act will eventually spur efforts to cover acupuncture and similar services under Medicare.

For now, she is pleased that at least more people will have an opportunity to try alternative treatments if they choose to do so.

Torrance agreed: “My hope is that the Affordable Healthcare Act will enable more people to seek the kind of health care they desire.”