Insurance Companies Begin to Cover Naturopathic Health-Care Visits

EXETER — A law officially taking effect in 2013, but already being implemented by three N.H. companies, requires insurers to provide coverage for services delivered by naturopathic doctors if those services would be covered when provided by other primary care providers.

And that has put patients who qualify for the coverage in a better state of mind.

“Instead of paying an almost $200 bill, I had to pay a $20 co-pay in my last visit. It’s amazing. It’s a huge change,” says Laura E. Mayer, a patient of Dr. Robyn Giard, an ND with a practice named Starry Brook Natural Medicine in Exeter, N.H.

Mayer is covered by Tufts Health Plan, which along with Cigna and United Healthcare, had started covering patients even before the law officially goes into effect Jan. 1. Blue Cross Blue Shield is waiting until New Year to implement its coverage.

Dr. Giard is the second naturopath from whom Mayer has sought care. “I believe in the work naturopaths do very much, but financially it has been very difficult,” she says.

In the past Mayer had to pay 100 percent of the bill, a situation that forced her to choose among necessary medical tests and procedures, postponing some to a later date. “I couldn’t get them all done because I didn’t have the money. Insurance and finances do direct care.”

A clinician, Mayer’s first impulse is to care for other people first. “When it comes to your own health you put it on the back burner and only get the treatment you can afford. But now I can afford it. It’s wonderful.”

Currently, the new law covers individual health plans and is optional for small group plans, which represent the majority of insured in the state. Dr. Giard’s office recommends that patients check with their naturopath’s office to see if they are covered.

Starry Brook has been diligently filing claims with the three health insurance companies since May, and asks patients to pay particular attention to “explanation of benefits” letters they may have received in the mail. It advises patients to bring a copy of their EOBs into the office to review how patients are being reimbursed.

"Different insurance companies reimburse at different rates for different codes,” Starry Brook notes in an email to patients. “Just because we've submitted once, does not mean we cannot resubmit for a different code. In fact, if you've been seen and had labs drawn, we submit day of service, but then often have to modify the claim once Dr. Giard has reviewed the labs and rendered a diagnosis. The game with insurance companies is who will give up first. We protect you — our patient — to ensure that you get the coverage from your insurance company, and we do not give up. Ever.”

Dr. Giard says that EOBs are difficult to understand and that in their first iteration they may be wrong. For example, when Dr. Giard injured her nose and required stitches to close the gash, she received a $2,000 bill, which seemed unlikely. Familiar with “procedure codes,” she asked for a detailed list of the procedures used to treat her. The code indicated that the sutures had been sewed to her torso rather than her nose and that she received an IV. “Four stitches across the
nose do not require an IV,” she said. A $2,000 bill was reduced to $125.

Starry Brook also advises patients to check the balance of their Health Savings Accounts. Money they do not use by the end of the year is forfeited. Most employers have a “use it or lose it” policy. “We know people who do every year,” Dr. Giard says, advising patients to examine their summary of benefit statements to determine their HSA balance.

It is ironic that, although naturopathic doctors undergo virtually the same training as medical doctors, their services had not been covered by insurance companies in New Hampshire. Naturopathic doctors emphasize illness prevention and lifestyle guidance rather than pharmaceutical or surgical procedures in their practice. About 75 percent of health-care spending nationwide goes to treating chronic diseases, particularly those caused by diet and stress, such as obesity, heart disease and diabetes.

Dr. Giard emphasizes an integrated, dynamic approach, one that combines the best of both traditional as well as natural methods of health and healing. Emphasizing complementary alternative medicine, Dr. Giard brings both products (everything from vitamins to prescriptive medicines) and services (massage therapy utilizing 100 percent organic oils, acupuncture, diet counseling, etc.) under one roof. Believing that the best care includes perspectives as broadly focused as prescriptions and nutrition, Dr. Robyn has established her practice as a one-stop shop for individuals and families, offering IV therapy, clinical nutrition, homeopathy, and other services in a peaceful, engaging setting.

During her time at Southwest College of Naturopathic Medicine, Dr. Giard’s primary focus was on clinical training in OB/GYN and mental health. Dr. Conte has been involved in extensive studies regarding the impact of nutrition on mental illness, including ADHD, depression and anxiety. She has good relationships with local psychologists and therapists. “I am pretty mainstream when it comes to routine care,” she says. Her office also specializes in chronic fatigue syndrome.

“They refer to me as their hippie doc,” Dr. Giard says of her patients. “I really try to think outside the box.”

Dr. Giard contrasts the time she spends with patients, often an hour for a first consultation, with the average seven minutes an MD takes. “I provide much better patient care,” she says, “by taking adequate time, listening to the patient and hearing what they say.”

Starry Brook is a business partner of the Green Alliance, a union of local sustainable businesses promoting environmentally sound business practices, and a green co-op offering discounted green products and services to its members. GA members save 20 percent off hourly consultation and service rates at Starry Brook, $50 on new patient consultations, and $19 on acupuncture sessions. And regularly scheduled, prepaid GA massage clients enjoy an hour-long massage for only $44 at Starry Brook.

For more information about Starry Brook, visit www.starrybrook.com, and for more information about the Green Alliance, visit www.greenalliance.biz.