Slow Death for Alternative Health?
Insurance Companies Stymie Insurance Commissioner Senn's Reforms
by Lisa Cheval
Free Press contributor
While Washington state tries to make headway with a nationally unprecedented healthcare law, local health insurance companies are threatening to entangle it with several strands of legal red tape.
The law, which was designed by a coalition of state leaders including Insurance Commissioner Deborah Senn, was made in response to Washington residents' rising use of natural and alternative medicines and healthcare. It states that every health insurance plan is to permit "every category" of health care practitioner to provide services that are allowed in basic health plans. This means that all fee-for-service and managed care plans should now pay for your visits to licensed providers such as naturopaths, acupuncturists and midwives if these alternative providers can treat a condition that is covered in your plan.
By providing access to alternative health providers, Washington state is now setting the stage for nationwide healthcare reforms. The "every category" statute is a surviving reform in the 1993's Health Services Act that was mostly shot down in the Republican-controlled legislature in 1995. Reforms that were eliminated included an employer mandate, which created a time-line for all employers to offer health insurance to employees, and a "community rating" process that called for regulation of premiums, regardless of the number of individual claims a member made.
While the law has sparked nationwide attention and praise, eleven local insurance carriers have responded by filing lawsuits.
The law became effective January 1 of this year, and insurance carriers including King County Medical, Group Health Cooperative, Blue Cross and others filed a lawsuit with the Thurston County Superior Court in February. The lawsuit was dismissed after the court determined that carriers needed to first hold an administrative hearing with the Office of the Insurance Commissioner (OIC). This hearing did not soon materialize. Instead, Senn issued a declaratory order to the insurance industry in August that outlined the carrier's responsibilities under the law. In addition to the declaratory order, Senn took enforcement actions against King County Medical (KCM) and Pierce County Medical (PCM) for failing to implement the law as written.
According to Brian Lautman, manager of communications at KCM, the company is already at the forefront of all carriers in terms of implementing the "every category of provider" statute. He notes that KCM has contracts with 300 alternative providers and already offers alternative healthcare services through their managed care programs. Lautman contends that managed care - which requires patients to first visit a "primary care physician" who can then refer the patient to an alternative care specialist - is the only way to keep down costs. This way, Lautman says, the company can control the amount of claims made by ensuring that claimants aren't abusing the system.
"Right now everyone is talking about costs - whether you're a Democrat or Republican," Lautman said. "Because we don't know people's utilization patterns and habits regarding alternative care, our issue is 'what is the best way to keep costs reasonable?' Until we know what costs there will be, it makes sense to put this into managed care."
But that's not the way the law was written, said the OIC. And for this incorrect interpretation, Senn slapped KCM with a cease-and-desist order that threatens a $10,000 fine or loss of their license if they refuse to comply. The same action was taken against PCM for a similar infringement.
A few weeks ago, an administrative hearing determined that the OIC cannot enforce the declaratory order with the insurance carriers. In the meantime, King County Medical and other insurers have filed another lawsuit, this time in Federal Court. KCM has also been granted a temporary restraining order from Thurston County Superior court that prevents enforcement of the law. The law exists, but currently only in limbo.
As it now stands, the state Legislature is the only body that can overturn the law, said Jim Stevenson of the OIC. The insurance industry has lobbied the legislature four times in an attempt to amend the "every category" statute, and has failed each time. As it has become evident to the OIC that the insurance carriers continue to drag their feet in enacting the law, it was Senn's job to enforce what the legislature decided, said Stevenson.
All carriers are still required to uphold the law as it exists, said Stevenson. The law is applicable to all fee-for-service and managed care plans, excluding the Basic Health Plan, which is regulated by its own state agency apart from the OIC. If members run into problems in making a claim with an alternative provider, complaints can be filed with the commissioner's office directly, he said. The number for the Consumer Advocacy and Outreach Division of the OIC is 1-800-562-6900.
Washington state continues to be at the top of its class in other alternative medicine developments. As of this fall, Washington became the nation's first state to fund a natural medicine clinic. The clinic, which is contracted to Bastyr University, is located in Kent. After the one-and-a-half year contract expires, additional funding sources will be secured.
With all eyes now on Washington state, let's hope for a happy and healthy transition to a more inclusive healthcare system that allows greater freedom of choice among medical traditions.
WFP's 1996 local election coverage continues with:
It's Time to Stop Waiting for the Interurban
AND
The Craswell Capers
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Contents on this page were published in the November/December, 1996 edition of the Washington Free
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