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Maine Alternative Health Care Providers Seek Place at ACA Table
03/12/2014   Reported By: Patty B. Wight

Of the thousands of pages that make up the Affordable Care Act, alternative medicine providers are paying a lot of attention to one paragraph in particular:  Section 2706 says that insurance companies can't discriminate against any health provider with a state-recognized license. It's supposed to open insurance companies' doors to include alternative medicine in network plans. But as Patty Wight reports, the reality isn't proving to be as inclusive as some had hoped.

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Maine Alternative Health Care Providers Seek Place
Originally Aired: 3/12/2014 5:30 PM

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Naturopathic physician Dr. Anne Jacobs (right) with patient Sylvia Asbury.

Six years ago, Sylvia Asbury from Boothbay wasn't seeing much progress while recovering from a severe case of shingles. "I couldn't get my strength back. I was very weak, I didn't feel good, didn't have energy," she says. "That was totally unlike me."

Asbury says her doctors told her to take a multi-vitamin. But that didn't seem to work, so on a friend's recommendation, she decided to try Dr. Anne Jacobs, a naturopath in Newcastle.

"When Sylvia first came in - you said, basically, 'I expect to be dead in a couple years.'" Jacobs says. "She felt so badly, and she said, 'I just have this feeling in me.' And we - we've gone way past that."

After being treated by Jacobs, Asbury says she now feels better at age 62 than when she was in her 50s. Asbury is one of the approximately 38 percent of adults who use some form of alternative medicine, according to the National Institutes of Health.

Naturopaths go to four years of graduate school where the first two years resemble conventional medical school, then diverge into learning about treatments that support the body's natural healing process - things like nutrition, exercise, and hydrotherapy. Anne Jacobs serves as a primary care provider for many of her patients, but most of her services aren't covered by insurance.

"It's been the minimal, basically, in terms of lab work. So they will cover lab work, but not cover the actual office visit that needs to happen in order to order the lab work, and then to interpret the lab work," Jacobs says.

Jacobs thought the Affordable Care Act would change that, because of one section - 2706 - penned by U.S. Democratic Sen. Tom Harkin, of Iowa.

"Section 2706 is very clear:  It says if you are a provider that is licensed in a state, and you provide the same service as another licensed provider, you can't discriminate against them," Jacobs says.

So, since last fall, Jacobs has asked Maine insurance companies to include naturopaths on their plans. Maine Community Health Options invited all of Maine's approximately 30 naturopaths to join. Cigna told Jacobs they're not required to include naturopathic doctors in their network.

As for the others: "'We're still looking into it' - quote/unquote," says Jacobs. "Those are the replies: 'We're still looking into it.'"

But one insurance company - Aetna - did tell MPBN it has made a decision about whether to include naturopaths and other alternative medicine like acupuncture in its network. "At this time, no, we're not," says Aetna spokeswoman Susan Millerick.

"You know, there are a number of different things out there that a number of people experience a great deal of relief from. And there's no questioning that experience," Millerick says. "But we need to have it studied, we need to have it documented, we need to have it questioned and really looked at carefully before we can go ahead and routinely cover it as a service that is equal to, or better than, traditional techniques."

Millerick says Aetna is following the guidance of Maine's Bureau of Insurance. Insurance Superintendent Eric Cioppa says he's following guidance from the federal Centers for Medicare and Medicaid Services, or CMS. "We're not interpreting federal law, we're enforcing federal law based on their interpretations," Cioppa says. "And our read of the current CMS guidelines is pretty clear."

Last April, CMS issued guidance that says section 2706 does not require insurance companies to accept all types of providers into their network. So what then is the purpose of this section? "I don't think that's an unreasonable question," Cioppa says.

Naturopaths have mounted a national campaign on the issue. The CEO of the American Association of Naturopathic Physicians, Jud Richland, says to comply with the law, insurance companies don't have to include all naturopathic doctors in their networks.

However, "if an insurance company were to exclude an entire class of health care providers like naturopathic physicians, like chiropractors, people who are licensed to practice their profession in that particular state, that would be discriminatory," Richland says.

Insurance plans in other states, like Washington and Vermont, included naturopaths in their networks even before the Affordable Care Act. Dr. Anne Jacobs says as someone who provides primary care services, she should be considered an asset to insurance plans.

"I want my patients to have access to whatever health care they choose," she says. "That's the bottom line."

The U.S. Senate Appropriations Committee agrees. Last year, the Committee asked CMS to reconsider its guidance on section 2706, saying:  "The goal of this provision is to ensure that patients have the right to access covered health services from the full range of providers licensed and certified in their State."

Last week, CMS announced it will invite public comment on the section for 90 days.

Photo:  Patty Wight


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