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I've had my doctor for the past 12 years; she knows me as a whole person, and not just as a 30 second "What's up? Okay, here's a prescription, now get out," doctor like other providers that I've gone to.  The only problem (though not to me) is that she's a Naturopath.  In Oregon, Naturopaths go through the same schooling, have the same admitting and prescribing privileges as an MD, etc, so there's no lack of care or worry that comes with going to a Naturopath.

And now Naturopaths have the weight of the ACA behind them.

When Obamacare first started, and health insurance companies had to become more strict with spending 80% of their premiums paid into them as actual healthcare expenses (instead of, say, for a lobbyist), things started cracking down.  For the first time ever, my doctor was refused coverage by almost every insurance company.  This meant that I had to pay out of pocket for medically necessary vaccinations (I work in hospitals) as well as for my yearly physical and labwork that was done as part of that physical.  My company provided healthcare insurance - two different companies over two different years - were "sympathetic" but happily pointed to the "We don't cover Naturopaths" to back up their refusal of service.

But a little known provision of the ACA came effective January 1st, 2014.  It's section 2706, and it states that licensed professional healthcare workers cannot be discriminated against when it comes to coverage, copays, or deductibles, as long as they are operating under the scope of their license.  So insurance companies can't say they'll pay 80% coverage with a $20 co-pay for a regular MD, while saying Naturopaths, and even Chiropractors, etc, aren't covered.  As long as the provider is working within the scope of their license, the insurance company has to pay, just like another provider.

Of course the insurance companies are balking at this - but the good thing is, they're losing.  My doctor visit from the beginning of April was denied coverage, so I and the head of my company's HR department started going after them.  They claimed they hadn't heard of Section 2706, so "We'll have to look into that.  But in the mean time, denied.  And appeal denied."

Two big Oregon companies have already started complying - Regence BCBS, the sister of the coverage I have (BlueKC) being one of them.  

So Naturopathic physicians and their patients celebrate!  And if you're stonewalled by your insurance company, there are steps you can take to put the odds in your favor.

Originally posted to walterhpdx on Sun Apr 20, 2014 at 08:44 AM PDT.

Also republished by Obamacare Saves Lives.

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Comment Preferences

  •  This is great news. I knew there are many (13+ / 0-)

    components of the ACA of which I am unaware (some  pro-consumer and others not), and figured we all would become more educated/enlightened as the roll-out continues each year.  Congratulations on being another recipient of evolving healthcare coverage.  I am praying that as the ACA improves more and more lives, the baby steps toward single payer will become increasingly rapid leaps and bounds.

    Thanks for sharing this important info with those of us who did not know about this provison.  Best of luck.  Stay well.

  •  It would be better (7+ / 0-)

    if the government only supported evidence based medicine rather than pseudoscience.

    •  You mean pharmaceuticals? Oh wait.... (3+ / 0-)
      Recommended by:
      jan4insight, New Rule, elmo

      If I knew it was going to be that kind of party, I'd have stuck my ---- in the mashed potatoes! - Paul's Boutique

      by DoctorWho on Sun Apr 20, 2014 at 09:51:53 AM PDT

      [ Parent ]

      •  Tu quoque (2+ / 0-)
        Recommended by:
        hnichols, Fonsia

        Are all pharmaceuticals perfectly tested? Is that what you're asking? Probably not. But most are. Is big pharma evil? Yes, but that doesn't mean every pharma product is evil. As opposed to most naturopathic remedies that are outside of mainstream medicine, which undergo virtually no testing. You're free to take your pick.

      •  My naturaopath (7+ / 0-)

        treats certain conditions, and for other things says, See an allopathic doctor.

        They're medically trained, engage in ongoing education, and recognize where their limits are. Unlike some of the allopathic guys I've run across.

        And their emphasis is on healing the whole person, addressing the underlying causes in order to eliminate the source of the problem, not just treating the symptom that shows on the surface. That requires a degree of patient participation that the current system prevents, because it involves a certain amount of time.

        Great Questions of Western Philosophy: How much wood would a woodchuck chuck if a woodchuck could chuck wood?

        by Mnemosyne on Sun Apr 20, 2014 at 11:06:09 AM PDT

        [ Parent ]

    •  Unfortunately (6+ / 0-)

      "evidenced" based medicine changes as the evidence changes.  That's what science is all about.  I do understand your point, but your point isn't as cut and dried as you would like to believe.  

      Just one example:  it used to be said (based on what, I don't know) that ulcers were due to stress.  Then one researcher got the idea that many were caused by a bacteria.  He couldn't get anyone on board with his ideas, so he ingested the said germ and got ulcers, then cured himself with anti-biotics.  Now most doctors know he was right, based on evidence that at first they wouldn't "believe."

      But there are a lot of questionable theories being peddled, and who knows who is licensing whom. When I see a medical product promoted as being "chemical free" I know that the seller is either completely ignorant of chemistry or trying to pull as fast one on consumers.

      I look out and all I can see is white.

      by Andy Cook on Sun Apr 20, 2014 at 10:07:57 AM PDT

      [ Parent ]

      •  The H. Pylori issue is complicated... (7+ / 0-)
        Recommended by:
        ZenTrainer, SoCalSal, AJayne, Lujane, elmo, 1BQ, Odysseus

        ...according to MY Naturopath friend, and the links she showed me, there are people who have H. Pylori and no ulcers, people who have ulcers and no H. Pylori, and people who have ulcers AND H. Pylori, and when you kill the bacteria their ulcers subside....Like me.

        My Naturopath friend is pretty careful to distinguish between stuff she can treat, and stuff that needs the attention of MDs...she doesn't bash doctors at all.

        "Ronald Reagan is DEAD! His policies live on but we're doing something about THAT!"

        by leftykook on Sun Apr 20, 2014 at 10:23:51 AM PDT

        [ Parent ]

      •  There is nothing unfortunate (3+ / 0-)
        Recommended by:
        hnichols, Fonsia, LakeSuperior

        about change. That's one of the big advantages science has over pseudoscience. Science isn't based on beliefs. Pseudoscience is. "belief" is a religious word. It relies on an understanding irrespective of evidence. Science based medicine doesn't. Hypotheses are posited, tested, retested and challenged. And when a hypothesis is proved wrong, it isn't a failure, it's a success. We have learned one more thing that isn't true.

        Traditional medicine isn't perfect. That acknowledgement does not make it the equal of untested alternatives that have no basis in science.

        •  I'm not sure if... (1+ / 0-)
          Recommended by:

          ... you are understanding that I agree with your points (before you made them.)  I was trying to convey that it is too simplistic to think that "evidence based medicine" is merely one set of facts that doesn't change.  You point out the necessity of using the scientific method to examine even ideas that may be long held and accepted.

          Unfortunately, in the minds on the severely science-under-educated American public, this "changing understanding" of how the human body works and how germs, medications, etc work, well, it comes across as no better than picking an idea off the net and sticking with it.  

          I have friends who sell some kind of green goo that is supposed to cure everything.  They can make big bucks.  I've read the website.  Lots of words are used to say we can't promise anything because the doses are "natural" not consistent, and besides, the govt doesn't require testing.  

          I have another friend who is enamored of an internet "doctor" who has been stripped of credentials by the university she came from for prescribing the same product to patients no matter what is wrong with them.  And of course, buy that product from her.  

          Too few of us have any background to evaluate the hype.  Just wait, the current crop of students, influenced by the righties who are influencing education, will be even worse.  So much for the information age.

          I look out and all I can see is white.

          by Andy Cook on Sun Apr 20, 2014 at 10:44:13 AM PDT

          [ Parent ]

        •  When you say Traditional do you mean (1+ / 0-)
          Recommended by:

          allopathic or the traditional medicine that has been around for thousands and thousands of years?

          Tracy B Ann - technically that is my signature. If I had Bill Gates money, I'd buy Detroit.

          by ZenTrainer on Sun Apr 20, 2014 at 11:03:23 AM PDT

          [ Parent ]

    •  that would be problematic (2+ / 0-)
      Recommended by:
      Angie in WA State, Odysseus

      for the conventional medical community.

      In addition, 363 of the studies tested a standard of care – an established medical treatment widely-accepted as the best method to treat a specific condition. More than 40 percent of these studies found the current established medical practice to be ineffective or harmful.
      Among the practices found to be ineffective or harmful were the use of hormone therapy in postmenopausal women; the use of allergen-impermeable bed covers for adults with asthma;  genetic screening before implantation for women undergoing invitro-fertilization;  and intensive glucose lowering in Type 2 diabetes patients in intensive care, which not only failed to reduce cardiovascular events but actually increased mortality.
      The bottom line, according to the study authors, is that patterns of medical practice often persist despite the evidence.
    •  The NIH is doing what it can via the NCCAM, the (1+ / 0-)
      Recommended by:
      Angie in WA State

      National Center for Complementary and Alternative Medicine. You can look up a condition or treatment and find out what the research says about it.

      preborner: (n.) one who believes that the right to life begins at conception and ends at birth.

      Repeal Benghazi!


      by 1BQ on Sun Apr 20, 2014 at 04:25:45 PM PDT

      [ Parent ]

  •  Medicare (3+ / 0-)
    Recommended by:
    Illinois IRV, ZenTrainer, jan4insight

    Does Medicare also have to comply?  My chiropractor has been keeping me healthy for years but it has cost me.  I have a Blue Cross supplemental insurance and but have a feeling they would give me a hard time.

  •  Are there any limits? (2+ / 0-)
    Recommended by:
    Thorby Baslim, guyeda

    NDs are indeed "real" doctors. (I had one as my primary care physician for several years, until I moved away.)

    But "licensed professional" covers a host of less-reputable, more-arguable people, both in the New Age realm and in the home-school/anti-vax one. Does equal treatment for mental health mean my premiums are going to be paying for seances and past-life-regressions and self-described "sex therapists" and a host of other things that would be better classified as religious rituals (or pornography or sex work)? I hope there are some limits on whose licensing and what kind of professional can get reimbursement under this section.

    •  NDs are not real doctors (4+ / 0-)

      They have nowhere near the training of an MD and the training they do have is pure quackery.

      Go to Science Based Medicine or Quackwatch if you want to become informed of reality based medicine.

    •  The limits are substantial, or minimal, depending (0+ / 0-)

      on how you view the issue.  The restrictions on insurer's behavior imposed by this provision of the ACA appear to be minimal.  HHS provided guidance on this issue last year:

      Until any further guidance is issued, group health plans and health insurance issuers offering group or individual coverage are expected to implement the requirements of PHS Act section 2706(a) using a good faith, reasonable interpretation of the law. For this purpose, to the extent an item or service is a covered benefit under the plan or coverage, and consistent with reasonable medical management techniques specified under the plan with respect to the frequency, method, treatment or setting for an item or service, a plan or issuer shall not discriminate based on a provider's license or certification, to the extent the provider is acting within the scope of the provider's license or certification under applicable state law.  This provision does not require plans or issuers to accept all types of providers into a network. This provision also does not govern provider reimbursement rates, which may be subject to quality, performance, or market standards and considerations.
      (Emphasis mine.)
      My take on this is that the only limitation for insurers is that if an ND in their network provides similar or equivalent services to that of an MD or DO in their network, the reimbursement rates must be the same.  Their is no requirement, however, for insurers to include NDs in their network nor is there a requirement to reimburse them at similar rates if they chose an alternative treatment methodology that is substantially different from that used by MDs or DOs.  There is also nothing within this provision that prohibits insurers from excluding coverage for treatment procedures that are not deemed medically necessary, safe, or effective by the broader medical community.

      John Weeks, an advocate for integrative medical approaches, views this HHS guidance "as a declaration that the plans and states can use 'reasonable medical management techniques' to essentially blow off the section."  I believe that the ability to receive coverage for alternative approaches will vary dramatically both amongst states and insurers.

  •  Insurance companies paying for quackery (6+ / 0-)

    is not a "win" for Obamacare. Being in the reality based community means requiring empirical evidence. Naturopaths do not have a shred of evidence for any of their practice. (Yes, they will sometimes recommend eating a better diet - not exactly rocket science.)

    Why would we pay for "treatments" that don't work. In many cases "alternative" treatments have been tested and proven to not work but this doesn't stop the quacks. They ignore evidence that does not fit their preconceived biases.

    Hmm. Pretty much like Republicans now that I think about it.

  •  Better doctors (0+ / 0-)

    I think the takeaway here is that the quality of care is a factor in the healthcare marketplace.

    The OP was willing to pay more in order to get a doctor who  will spend the time to build a personal rather than just a transactional relationship.

    Boutique 'Comprehensive Care' medical groups are on the rise - they charge a premium but deliver same or next-day appointments, allow you to communicate with your doctor via email, etc...

    OP - if rejecting evidence-based medicine doesn't strike you as ludicrous, please think about it some more.

  •  Naturopaths do not have admitting (4+ / 0-)

    privileges in Oregon.  They only do outpatient work.  They may order tests such as x-rays and lab at hospitals for outpatients only.  They do not order these tests on inpatients in the hospital.  They do not have the same training as MDs or DOs.  These training programs are separate and somewhat different.  Naturopaths have a long training program and have a Board for certification but it is a different Board from MDs and DOs.  Naturopaths do not prescribe medications that require a prescription.  They can recommend homeopathic or herbal preparations.  They do not do surgery other than minor office procedures such as repairing superficial wounds.

    None of the above is in any way meant to be interpreted as disparaging to Naturopaths or MDs or DOs.  I think there is a place for all these practitioners, as well as Chiropractors, Nurse Practitioners and Physicians Assistants.

    It is important to understand what training and skills your provider has.  And, as providers, it would be in patients' best interests for us to work together cooperatively.

    I was wise enough to never grow up while fooling most people into believing I had. - Margaret Mead

    by fayea on Sun Apr 20, 2014 at 11:35:06 AM PDT

  •  Patient satisfaction (1+ / 0-)
    Recommended by:
    Kane in CA

    The American medical system uses patient satisfaction as its measurement of value.    Its why some hospital rooms are more like Hilton suites than an old fashioned hospital.

    Treatments that are based in self reported effectiveness are faith based, and have no business being covered by the ACA.

    I would be fine with the ACA covering only those treatments that can be proven to work.  That would leave out most of the new age treatments, and a significant section of the traditional medical treatment.

  •  My gold policy (0+ / 0-)

    says it does not cover chiropractors. I should look into this cause i need an adjustment and was going to pay out of pocket

  •  Oh geez (0+ / 0-)

    I would count this as one of those things we need to fix about Obamacare. You don't hold down healthcare costs by shoveling money to the modern version of the witch doctor. Insurance companies don't like covering naturopaths and chiropractors for the same reason they probably wouldn't be on board paying for you to visit a shaman for him to pull the evil spirits out of your body.

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