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| INSURING ALTERNATIVES | |
 July 3, 1996  | |
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ROD MINOTT: When it comes to a cold, stress, or aches, Deborah Senn says she now swears by her acupuncturist for health. DEBORAH SENN: I found that treatment by an acupuncturist for me has been very effective. I had a shoulder problem, and she treated it, and, and it was successful. It made a believer out of me. MR. MINOTT: Enough of a believer that as insurance commissioner, Senn has spearheaded a new law that allows consumers greater access to alternative medical care. Under Washington State's pioneering law, the first and only one of its kind in the nation, insurance companies must be reimburse for alternative types of health therapies, such as this visit to a naturopathic physician. Insurers are required to cover every category of health care professional licensed by the state, including naturopaths, massage therapists, nutritionists, and acupuncturists. DEBORAH SENN: The single biggest issue in health care is choice. People say I want to have my choice of doctor, I want to have my choice of health care provider. And what this law provides is choice. MR. MINOTT: Many Americans are choosing alternative medicine, according to a recent study by the "New England Journal of Medicine." The report found one in three Americans using some form of alternative medical care, spending up to $14 billion a year, most of that out of pocket. Diane Privett says alternative care has helped change her life. Frustrated with traditional medical doctors, she recently turned to a naturopathic physician to treat a nerve disorder. Previously, Privett's insurer would not cover visits to her naturopath. Instead, she paid out of pocket up to $700 a year. DIANE PRIVETT: We were paying so much in health insurance premiums and then to have to go and pay additional out of pocket was just, just seemed ridiculous, and yet, he was offering me much better care for this problem than I was getting through the traditional system. DOCTOR: (talking to patient) Any pain? MR. MINOTT: Today her care includes natural therapies that stress nutrition, diet, and exercise. DIANE PRIVETT: The naturopathic doctors spend much more time getting to know the patient as a whole person. They seem to be much more interested in help maintenance and not just trying to treat something once it's very obviously abnormal, try to catch it early. MR. MINOTT: Legislation mandating coverage of alternative care was passed originally in 1993 as part of a package of major health care reforms. Lawmakers later repealed most of those reforms but kept the alternative care provision which took effect this year. DEBORAH SENN: I believe the reason that it's kept intact is because it's so popular with the public. 45 percent of the people in the state of Washington use alternative providers. MR. MINOTT: But the law hasn't been popular with the insurance industry, which according to Deborah Senn, has tried several times to get bills passed that would weaken the legislation. MARGARET LANE, King County Medical: I do know that although one visit to an alternative provider costs less than a visit to a regular doctor, people go much more often. MR. MINOTT: Margaret Lane is with King County Medical, one of the state's largest insurers. MARGARET LANE: Internally, we looked at the costs of adding the new providers and implementing it under all of our plans without any limitations and believe that it would cost consumers up to $500 million in increased premiums on an annual basis, and we think that, that goes too far, and that's too much money. MR. MINOTT: Insurers sued Deborah Senn over her enforcement of the law, claiming it was too broad and would raise costs. But a judge recently threw out the lawsuit, ruling that insurers should have sought an administrative remedy first, before going to court. Insurers are not the only ones complaining. Managed care organizations have also criticized spending health care dollars on what they see as unproven controversial treatments. Simeon Rubenstein is with Group Health Cooperative, the state's largest managed care network. DR. SIMEON A. RUBENSTEIN, Group Health Cooperative: But the real question is: Are these effective? Are they helpful? Do they improve health? Are they cost effective? That's really the key issue, and there's not been a lot of research done in many of these areas. MR. MINOTT: But Aaron Katz, public health expert at the University of Washington, says when it comes to funding major research, the government continues to favor traditional medical care over alternative therapies. AARON KATZ, Public Health Analyst: Because I mean on the one hand we're saying you have to live up to the scientific standard that, that determines whether what you do is effective and on the other hand, umm, we don't have the money to do the research that would show whether you're effective or not. MR. MINOTT: As for alternative medicine providers, they are finding out that being part of the mainstream is no panacea. They are encountering all the problems traditional practitioners have been complaining about for years. EILEEN STRETCH: Why don't you come on in here today. MR. MINOTT: Dr. Eileen Stretch, a Seattle naturopath, says she's upset because insurers are restricting alternative providers like herself to managed care plans, plans that dictate which doctors patients can see. EILEEN STRETCH, Neuropathic Physician: There are some companies that are great, you know, the patients can choose us as their primary care physicians. We file the claims. They pay the claims. There are other companies that are calling us specialists. They're restricting patients to four or five diagnoses that actually, umm, there are many other diagnoses that we certainly could help people with. And then the other thing is the slow pay that we've been experiencing. Umm, it's been very, very slow. MR. MINOTT: Dr. Stretch says she's worried about the impact managed care might have on her practice. As an example, she says she likes to spend one hour with first-time patients, but insurance plans will only pay her for 40 minutes. Stretch thinks reimbursement standards should be different for her type of medical care. EILEEN STRETCH: A third thing would be the hypoallergenic diet. We think that our relationship with the patient is very important, and we tell our patients we're going to accept insurance, but if insurance companies tell us that we can't spend 30 minutes with a patient or even an hour on a first office call, then it's not going to work, because our medicine is based upon the person's healing process and our ability to help them heal. DR. SIMEON A. RUBENSTEIN: There are going to be some restrictions based on demonstrated effectiveness. It's true for physicians. It's true for hospitals. It's true for nurses. The mainstreaming of alternative medicine is going to put alternative medicine under the same scrutiny, the same pressures, and the same required accountability that we put everybody else under in the last few years. MR. MINOTT: Naturopaths also ought to be considered as primary care physicians. While some insurers are willing to go along with that, others still refuse. According to Dr. Rubenstein of Group Health, naturopaths don't meet that managed care network's criteria to qualify as primary care doctors. DR. SIMEON A. RUBENSTEIN: Right now for a physician it requires four years of education in medical school and three years of a residency, and a certain exposure to the types of problems that might confront a primary care physician. In our discussions with naturopaths, we were absolutely convinced that their experience nowhere approaches that of a physician. DOCTOR: Let's take a look in your ear here. MR. MINOTT: But the new law is making traditional and alternative medicine work together more closely, and that makes many patients like Diane Privett happy. DIANE PRIVETT: Of course, I'm obviously hoping that they will learn to interact because I don't think it's, you know, either naturopathic medicine or traditional medicine. I think that they all have something to offer, and they have strengths in certain areas. DOCTOR: So here is Diane's card. MR. MINOTT: For now, Privett thinks alternative medicine offers her more help. Even so, other states are choosing to wait and see if Washington State's bold experiment ends in success or failure before adopting similar reform of their own. |
