Trees

Navigating CoverOregon and Obamacare

December 11, 2013

Filed under: blogs,clinic updates,in the news,Uncategorized — Orna @ 10:02 pm

 

So many options. Which is the best fit for you?

Like so many Americans, I’ve been tearing my hair out trying to figure out my personal medical-insurance options under the Affordable Care Act (ACA or ObamaCare). My priorities: Overall coverage, a broad network and access to naturopaths, chiropractors and acupuncturists. (Every single option saves me $200 to $300 over my existing insurance.) 

 

From a professional perspective, the ACA had great promise for people looking for naturopathic care. The federal law contains a provision requiring insurers to cover doctors acting within the scope of their license. Since NDs are trained and licensed as primary-care physicians, and since there aren’t enough primary-care physicians in the US, you’d think inclusion would be a no brainer. Unfortunately it’s not, and Oregon insurers can and mostly do limit your access to naturopathic care — hurting anyone looking to NDs to provide the mainstay of their healthcare. (If this sort of thing makes you unhappy, get in touch with the Oregon Association of Naturopathic Physicians, which lobbies on behalf of all Oregonians to expand access to natural healthcare.)

 

The news isn’t universally bleak, however. Oregon’s Health Co-Op allows naturopaths to join as primary-care providers (PCPs) if they meet stringent criteria including hospital referrals and 24-hour access. PacificSource and LifeWise universally cover ND office visits like any other doctor’s visit — including the no-deductible preventive-care visits for wellness and annual gynecological exams. THey don’t, however, count NDs as PCPs for some purposes. And without an “alternative-care” benefit, in-office procedures such as physical medicine, massage or even B12 injections. Some of the higher-priced plans through Health Republic and Providence cover NDs. Kaiser doesn’t cover NDs but does cover chiropractic. You’ll need to talk directly to the companies to find specific limits on coverage.

 

 

Naturopaths help patients be healthy and happy.

Moda (formerly ODS), one of the few plans on the CoverOregon exchange offering “alternative-care” benefits, lumps naturopaths in with chiropractors and acupuncturists with a combined annual benefit limit. NDs are specifically not covered as regular office visits. The company also is rationing access to NDs by limiting the number they allow in as preferred providers. They’ve said their network is closed to new naturopathic providers, but NDs who join practices with other in-network doctors can bypass those limits. That effectively discriminates against newer solo practitioners or groups. We’ve spent four years so far trying to get in network with the company, and we’re continuing our efforts. (See our insurance page for more information on Celilo Natural Health Center’s networks.)

 

When looking at the dizzying array of medical-insurance options, it’s hard finding the right balance. Having a good insurance advisor can be a great boon, and that’s what I’ve relied on to make my personal decision. These advisors don’t cost you a dime; they only get a small fee from the insurance company if you sign up through them. I have worked with Rachel Novak at Broad River for several years and recommend her highly.

 

 

 

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