Naturopathic Docs Want Bill to Ensure They are Classified as Primary Care
Many patients see a naturopath as their primary care provider and clinics such as ZoomCare use them interchangeably with nurse practitioners. But a quarter of the insurance companies charge special copayments for naturopaths or don’t allow them to bill for preventive services.
Chris Gray
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.
Mar 25 2015
