Covering the Alternatives

by Cara Gardner


Thanks to the onslaught of pharmaceutical advertising, we all know what "the purple pill" is. In fact, plenty of us have an expanding mental index of the vast array of allergy, erectile dysfunction and heartburn medications -- even if we don't have allergies, erectile dysfunction or heartburn.


"That, to me, is silly," says Norrine O'Mara, a licensed acupuncturist with Synergy, a holistic healing clinic in Spokane. "'Do you have the purple pill? You need the purple pill! Ask your doctor about the purple pill.' I think there's a subtler way to do things. Real healing comes when people put in the work and effort and take time to go through the layers of things that's happened to them and their bodies over the years."


There's no doubt that medicines save lives. Some people can't live without the pills they have, and pharmaceutical research has introduced a quality of life for many who otherwise would never have been able to escape the confines of their illness. There's nothing wrong with pills, per se. But even though pill-popping has become a national pastime (U.S. pharmacies dispensed more than 3 billion prescriptions in 2003), thousands of Americans are turning away from the orange prescription bottles and tuning into their chakras, herbal remedies and the simplicity of whole foods.


"Definitely within the past few years there's been a big increase in people wanting alternatives for their health," says Pamela Langenderfer, a naturopathic doctor and licensed acupuncturist with Coeur d'Alene Healing Arts. "People are taking more responsibility for their health, and because of that people have been seeking out acupuncture and naturopathy and other providers."


There have always been (and will always be) bizarre healing rituals, like snakebiting, chanting and bleeding out. Most of us cringe at the thought. But the alternative treatments that more people are seeking have less to do with superstitions and more to do with coupling conventional medicine with holistic alternatives, or as it's called, complementary medicine. Complementary medicine connects the gap between holistic healing, which seeks answers to ailments by looking at the connections between body, mind and environment, and conventional medicine, which has traditionally focused on illness and injury, seeking answers to ailments through drugs and surgery. Combining both powerful paradigms may well be the future of healthcare.


"It's not a turf war like it was 10 years ago," says Todd Schlapfer, a naturopathic physician at Coeur d'Alene Healing Arts. Schlapfer says contrary to what many believe, conventional medical practitioners embrace many forms of complementary medicine, and students in medical school are being taught some of the ideologies of alternative treatments, resulting in a newfound respect for tried-and-true holistic healing methods.


"Clinics research on all levels and are integrated on different thought processes and on how to make things better. A lot of my clientele are [medical] providers who want to learn," Schlapfer says.





Getting It Covered -- According to the National Center for Complementary and Alternative Medicine (NCCAM), 36 percent of adults over the age of 18 use some form of complementary alternative medicine. And most of them pay out of pocket for it.


"One reason [insurance companies don't cover alternative medicine] is because the insurance system was set up to cover the diagnosis of and treatment of disease," explains Joe Pizzorno, a naturopathic doctor and midwife. Pizzorno is also founding president and now president emeritus of Bastyr University in Seattle, one of the nation's only accredited naturopathic schools. Bastyr is at the forefront of research in complementary and alternative medicine. It's also one of the most powerful institutions influencing insurance companies to include licensed alternative medical providers in their policies. "The other reason they don't cover alternative practices is because they think, 'If people are willing to pay out of pocket for it, why should we pay?'"


Pizzorno is out to change that. He was part of a commission appointed by former President Bill Clinton to draft a white paper on how to incorporate natural medicine into the mainstream healthcare system.


"We said, 'Yes, we should incorporate it and it should be done in a safe and responsible way.' The ways to do that were to increase research, ensure education [of providers] is of high quality and to ensure natural medicine practitioners are properly licensed," Pizzorno explains. So far, licensing has been the challenge for many states, like Idaho, which is one of the few states in the west that doesn't have state licensing standards for alternative and complementary providers.


"What happens is when states [create] licensing for naturopathic providers, the unlicensed practitioners move out and go to the states that [don't] license," explains a woman who works in a holistic healing center and did not want to be identified. "Oftentimes those people have paper mill degrees. Idaho has lots of them."


Even when states have licensing standards, before an insurance company will list them as one of its approved providers, the insurance company must certify the practitioner.


"The [insurer] has to provide its own assurance that those who are covered are following a standard that's virtually national, that represents a standard of practitioners belonging to the issues of safety and welfare," says Schlapfer. As a naturopathic physician practicing in the state of Idaho, Schlapfer is working hard to get state legislation passed regarding licensure of alternative practitioners. Still, he stresses that state licensure and insurance certification are completely different processes. But Pizzorno says the licensure and certification go hand in hand.


"It's foolish for insurance companies to cover [a provider] who's not licensed," he says. "Insurance companies are extremely unlikely to cover someone who's unlicensed."


This is partially why, in Idaho, no insurance company covers alternative or complementary practitioners.


"In Idaho no insurance companies are covering acupuncture or naturopathic medicine," says Langenderfer, with Coeur d'Alene Healing Arts. What some have done is a discount program. For example, there are some [insurance policies] where a person can be in a 'valued customer' or 'discount' program where they have a list of providers for acupuncture and can get a discount. But they're still paying out of pocket." The problem with this is that the truly qualified practitioners have nothing official to separate themselves from those with paper mill degrees, trying to practice without good training.





An Ounce of Prevention -- While Idaho remains one of the few states in the west that doesn't license alternative and complementary providers, its next-door neighbor is considered the most progressive state in the country when it comes to insuring alternatives. Thanks to Pizzorno and Bastyr University, Washington state is at the forefront of alternative and complementary healthcare coverage -- healthcare insurers in Washington are required to include alternative and complementary providers in their policies.


"Washington has 'every willing provider' legislation that all licensed [alternative] providers be included in the insurance. Washington is the most advanced state in terms of covering all naturopathic providers," Pizzorno says.


The "every willing provider" legislation doesn't force healthcare insurers to cover all alternative treatments; instead, it views alternative and complementary providers the same as conventional medical providers, so treatments like acupuncture, massage, chiropractic work or even a check-up with a naturopathic doctor is covered comparably to a visit with an M.D. Still, there are holes. For instance, when April Cathcart, a Spokane resident and single mom, began having health problems that she felt could be managed with complementary medicine; she found that her insurance, Basic Health, Washington state's low-income health plan, wouldn't pay.


"When I was starting to have problems with fibromyalgia, the joint pain was huge," Cathcart says. "I couldn't get any preventative stuff covered. They said the only options I had were joint reconstructive surgery or painkillers. I asked for something else, and [the insurance representatives] said that was it."


Cathcart pays out-of-pocket for massages that manage her chronic pain. It's expensive for her, but if her insurance covered it, it'd be minimal compared to what the company would be paying if she had surgery and took pharmaceuticals.


"I was going to deliver a woman's baby in her home," Pizzorno explains as another example of how insurance companies dictate the kind of treatment a patient receives. "But the insurance company would not cover it. It was cheaper for the parent to deliver [her baby] the expensive way."


Supporters of alternative and complementary medicine claim it's backward thinking for insurers to refuse to cover preventative treatments, and insist on only covering more expensive, intervention-based medicine, like pharmaceuticals and surgery.


"For instance, if I were to administer a lab test to determine what someone already had, that would be covered," says Pizzorno. "But if I were to do a lab test to pinpoint something [a patient] may be prone to getting, well, that would not be covered." Pizzorno says these policies hinder good medical care.


"I'd like to have a test to see how well someone's liver detoxifies chemicals. Well, [insurers] wouldn't cover that test. To some, that's foolish; the earlier you detect [an affinity for disease], the earlier you can prevent it."





Competition Is Coming -- For years consumers have dealt with limited choices when it comes to healthcare their insurance will cover. For example, "thick carpet" painkillers or invasive interventions like surgery are the only option available, when oftentimes, people want to try more subtle techniques, like massage, acupuncture or chiropractic work.


Slowly, though, this is changing. Pizzorno says in the future, even vitamins will be covered.


"In the long run, we can make the cost savings case," he says, "not to insurers, but to payers. Seventy percent of healthcare costs are paid for by corporations. Our job is to convince corporations that [complementary medicine] makes financial sense to them, and they'll put pressure on the insurers."


Paying for monthly acupuncture, massages and preventative treatments for your employees: expensive. Paying for cancer treatments, arthritis pharmaceuticals and diabetes care: even more expensive.


"I used to be in corporate America and was the vice president for human resources for REI," says O'Mara, the acupuncturist in Spokane. "I was responsible for benefits administration, and we were one of the first companies to talk about preventative medicine because we had generally healthy and active employees and wanted to keep them that way. So our insurance was on the forefront to cover preventative measures, and we found it very beneficial. The insurers used to look at [REI] as a test population, to see how it was going. That was a long time ago, but it sets the stage for what's happening now.


"The short term costs look like they spike," O'Mara continues, "but we're talking about prevention of serious disease and things you don't want to get: cancer, MS, the difficult things that cost enormous long-term care dollars."


Schlapfer, the naturopathic physician in Coeur d'Alene, says public demand will play a big part in shaping how insurers look at covering healthcare, too.


"People ask for healthcare providers who have alternative medicine," he says, explaining that it's fast becoming a 'blue chip' option and a form of competition among health insurers to offer coverage for alternative treatments. "People are paying out of pocket for it because they value it, and it puts more demand on insurance companies because they are missing out."





Publication date: 07/22/04