The Legislature may be stepping in to settle a dispute between health insurance companies and naturopathic physicians, who argue that the companies are misclassifying many of their providers as speciality care and subjecting patients to hire out-of-pocket fees.
Some insurance companies have cast naturopaths off with chiropractors, acupuncturists and massage therapists as an auxiliary service, which are covered differently, if at all.
But naturopath Jeff Clark of Tualatin testified that many if not most naturopaths work not as an auxiliary healthcare service but as a patient’s primary care provider. “I am a contracted in-network provider for most of Oregon’s major health insurance carriers,” Clark said. “I bill the same codes as MDs, offer the same services as other [primary care providers], and use all the same forms and paperwork.”
Sara Gillham, a naturopath at ZoomCare, said that her clinic chain uses naturopaths interchangeably with nurse practitioners and physician assistants, and it could often be the luck of the draw what class of provider a patient might see when coming to ZoomCare for quick healthcare attention.
<“If it happens to be a naturopath in the clinic that day, they have to have either preventive services subject to a deductible or have a higher copay or coinsurance,” Gillham said. “This really has been a problem for our patients.”
She said this discrepancy doesn’t occur for all their patients, in fact, only one-quarter of those with insurance have a health plan that charges higher out-of-pocket costs for naturopaths than nurse practitioners.
House Bill 3301 was introduced by Rep. John Lively, D-Springfield, a member of the Health Committee, who said he had used a naturopath for his own health needs but experienced widely variable coverage from his insurance company. The bill would require insurance companies to let a naturopath determine the type of medicine they practice -- primary care or speciality care -- and bill accordingly.
“One of my big issues is access and letting people be allowed to work to the height of their license,” Lively told his colleagues.
Oregon has long been a leader in including the naturopathic care perspective in the menu of healthcare options available to a patient, and the National College of Natural Medicine in Portland is the oldest of four schools accredited in the United States to train naturopaths.
A naturopathic doctor in Oregon can diagnose and treat disease, perform physical exams and all preventive services, order diagnostic labs and imaging, prescribe all pharmaceuticals needed in a primary care practice, coordinate hospital care, refer to specialists, and perform minor surgery. Oregon Association of Naturopathic Physicians lobbyist Ryan Fisher said their work was comparable to a nurse practitioner.
Clark said that if patients see a naturopath classified as a specialist, the copayments will often be twice as much as a primary care provider. “Most insurers also do not allow specialists to provide preventive health services such as well-woman visits, childhood vaccinations and annual physical exams,” he said.
Tom Holt of Cambia Health Solutions testified on the bill but didn’t oppose HB 3301 outright -- he said that Cambia and its chief subsidiary in Oregon -- Regence BlueCross BlueShield -- does include naturopaths in its network, but wanted the language changed so that the insurance company could still determine which providers are primary and which are considered speciality.
ZoomCare lobbyist Len Bergstein objected to this request, saying it’s what caused the problem in the first place, and suggested a third party, such as the Oregon Board of Naturopathic Medicine assign provider type.
Rep. Mitch Greenlick, D-Portland, asked Lively to work with Holt on an amendment before HB 3301 can clear the House Health Committee.
Disclosure 1: I have worked as a medical model at the National College of Natural Medicine. I do not represent NCNM though. I am a contract worker, and I did not sign up for a regular schedule next term.
Disclosure 2: I have serious medical issues in my background. I am 65 and medication-free. According to reports of how many my age take prescribed medications, I guess I am "healthy," though I am aware that healthy older people are not in as much demand in some industries as healthy young people are.
I choose to use natural medicine. I feel it is why I am still here. I feel profoundly disrespected by Mitch Greenlick and Tom Holt, though I feel pretty confident they were not intentionally disrespecting me. I am not sure the regular readers here would expect someone like me to be reading this article. I met Diane Lund many years ago at a conference, and that is why I happen to be here--pretty random. .
I want to decide on my own recognizance who I will see as primary care. The bill without amendment respects me more than a bill that restricts care to the type of care I avoid when I can choose, if I want my premium to count for anything.
I also carefully avoided the group Tom Holt represents, when I made a Medicare choice, as I could have predicted what I consider to be unwise business practice by that group in this matter.
Many cohorts among our population feel as I do and avoid conventional medicine unless referred by Carers (a word sometimes used in the UK for health-care workers). Conventional M.D.'s are not likely to see many of us unless we are carried in and cannot protest, even if government makes us pay more for service that might otherwise cost less, as primary care.
Many of us want to be seen in our own neighborhoods by people we know and trust. If a Carer we trust says we should see someone else, we might go where our chosen medicial home asks us to go, as a referral.
I am not seeing enough of a patient-centered outlook here. We are not just protoplasm to be argued over for coding purposes. This attitude toward people needing care constitutes a serious problem in the U.S. It fuels medical tourism from here, though I will also concede there is some medical tourism that comes into the U.S. from offshore. People of extreme advantage can go wherever they want.
Some insurance carriers probably do make the patients the arbiters, which likely saves them money. People who have a strong sense of agency over their own lives are often healthier.
Why can't all insurance carriers respect their prospective and current premium-payers?
Could Oregon make a law that respects that category of person known in the U.S. as patient? To the best of my knowledge, Oregon would be first, or at least among the first, if the state were to do this.
I do not know who reads these comments, but I feel better for getting this into someone else's court. Medicine is something of a free world-wide market for advantaged people. For less advantaged people, not so much. It could be better.
Mary Saunders