The Hawaii health insurance provider Hawaii Medical Service Association (HMSA) will let you choose a naturopathic doctor as your primary care physician, according to a recent agreement between the insurer and the Hawaii Society of Naturopathic Physicians. This is a big step forward for naturopathic doctors, according to Dr. Karen Frangos, a practicing naturopathic physician on Maui and the President of Hawaii Society of Physicians.
“It allows us all kinds of privileges in terms of being able to be part of a professional physician organization like all other medical doctors do,” says Frangos. “Potentially admission privileges in hospital settings, so it’s a big big deal. It helps close the gap in the shortage of primary care physicians in Hawaii.”
Right now, HMSA offers out-of-network provisions for naturopathic doctors who’ve registered as a non-participating provider. Dr. Marsha Lowry, a naturopathic doctor at Whole Body Wellness in Makawao and Hale Malu in Wailuku, says this reimbursement covers around 80 percent of the cost for her HMSA patients.
“On paper I love the idea of PCPs, but what concerns me is if there is a situation that they may choose to not reimburse for the visit if naturopathic treatments are used or recommended,” says Lowry. “I love that people would be able to have coverage. But right now they have been really great to me as an out-of-network provider, and that hasn’t happened. What has happened with other insurance companies is they are auditing our charts and kicking back things like prescribing an herb, and saying it’s not MD standard of care. It’s possible, only because it’s happened recently with UHA [University Health Alliance].”
Things could be different as an in-network provider for HMSA, but the Hawaii Society for Naturopathic Doctors is calling it a success with regard to the Affordable Care Act.
“Several meetings over the last month with them in Honolulu–them being some of the management, upper management, and the chief medical officer within HMSA–have culminated in a willingness to comply with the Affordable Care Act,” says Dr. Frangos. “There is a non-discrimination clause in Section 2706 of the Affordable Care Act that states all the insurance companies are to reimburse for services rendered within the state for licensed practitioners practicing within their scope, effective January 2014. But none of the insurance companies have been compliant. So for the last two years, we have been working on this. HMSA has finally agreed to naturopathic physicians in Hawaii to be credentialed as primary care physicians. Hawaii’s licensing law allows us to be primary care physicians yet none of the insurance companies have been allowing us to be participating primary care providers in their plans.”
Other plans like UHA and the Hawaii Medical Assurance Association (HMAA) allow for out-of-network care similar to HMSA, but each insurance provider differs on what they cover. But HMSA is the biggest health insurance provider in Hawaii–in fact, Lowry says 70 percent of her patients have HMSA.
Lowry says she treats patients for auto-immune disorders, endocrine issues as well as pediatric and family care. Right now, fees for an average visit can range from $75 to $175.
“In some cases, we have been allowed to be non-participating care providers, where patients have to pay upfront and get considerably less reimbursement,” says Frangos. “But none of the insurance companies have let us be participating network physicians, until now. Some insurance companies have closed their doors on us altogether. Kaiser won’t let us do anything.”
Frangos says the Hawaii Society of Naturopathic Physicians is also involved in other legislation this year, like SB 318, which compels insurers to cover care provided by naturopathic doctors. She is also working on SB 1034, which will lift the cap on the number of visits related to personal injury protection benefits provided through motor vehicle insurance. And Frangos says the Hawaii Society of Naturopathic Doctors will work on HB 1952 and SB 2332.
The former regards network adequacy, while the latter allows naturopathic doctors to prescribe controlled substances like Viagra and pain medication.*
According to Shelly Kunishige of the state Insurance Division, Hawaii Insurance Commissioner Gordon Ito has confirmed that HMSA is credentialing naturopathic doctors as primary care physicians. But she did not know the timeline or if any other insurance companies would follow suit.
“As of Thursday last week, we will soon be able** to start the paperwork for the process of credentialing as primary care physicians under HMSA, says Frangos. “We are still drafting the documents but basically we can begin the process. What will happen is within 90 days or so from the start of the credentialing process they will approve or deny the application. The only reason they wouldn’t is if we have some kind of a record against us with malpractice insurance, things like that. Other than that, if we have attested that as long as we can provide the services that they deem necessary to be PCPs, they will approve us.”
UPDATE, Feb. 5, 2016:
Robyn Kuraoka, a representative from HMSA, says the company is still working out the paperwork process for credentialing doctors and does not have a solid ETA yet for their customers.
“We have signed the contracts and the paperwork has begun,” says Kuraoka. “However, we do not have a timeline yet for when a patient could actually sign up a naturopathic doctor as their primary care physician. Right now because this is so new for us, nobody has a timeline. The first steps have been taken already. This is something that is going to happen. Now they are working on the details of what needs to be done.”
*This statement had originally mis-attributed information on SB 2332 to Dr. Frangos. It has been corrected.
**This statement originally mischaracterized the paperwork process timeline, and has been corrected