Pulse of Oriental Medicine: Alternative Medicine That Works for Regular Folks
Alternative Medicine That Works for Regular Folks








    "I am a newly licensed acupuncturist and I want to tell you how much I appreciate the Pulse and the Being Well newsletter. Your writing style never ceases to amaze me - it covers the issues in a straight forward, very professional yet easy to understand format. You explain things in the same manner that I try to educate my patients - although in a more organized (and complete) way than I am able to! Thank you so very much for your time and your loving dedication to our profession."




How We Pay For Healthcare:
Medical Insurance Problems and Alternatives
By Brian Carter, MS, LAc

Brian is the founder of the Pulse of Oriental Medicine, medical professor at Pacific College of Oriental Medicine, and author of Powerful Body, Peaceful Mind: How to Heal Yourself with Foods, Herbs, and Acupressure.

Healthcare practitioners of all medicines, whether MD, chiropractor, or acupuncturist face a dilemma in who pays for healthcare, and how that decision affects the quality of medicine. Insurance and HMO's, such as they are, inevitably mean higher cost and lower quality care. You, as patients and practitioners, do have power to affect this problem.

Not the Best Use of Your Money
33% of the U.S. population has no (zero) medical expenses each year. However, most people want the 'in case' benefits of insurance (in case you get sick, in case you get hit by a car, in case you fall off a ladder). Because of high deductibles and unused funds (by people who aren't sick), insurance is a good business. Your unused healthcare funds go into their pockets. Plus, most policies have little or no provision for preventive medicine. If you are healthy enough to not use your insurance, wouldn't you want to use the money you've paid in for prevention? Or to save it for retirement?

The Worst Thing That Could Happen to Acupuncture
In the first meeting of our Clinical Science II class, ER Doc and PCOM professor, Dr. Timothy Carman, MD recalled how excited his acupuncturist friends were when insurance companies first began reimbursing for their patients' treatment. "What do you mean it's great?" he asked, astounded. "Insurance is the worst thing that could happen to acupuncture! These guys that work at the insurance company who make $10 an hour call me up and tell me to put my patient on this or that drug... I say, what are you kidding? Who is this?" Insurance company employees with maybe 4 years of education regularly dictate how the patient is to be treated to an MD who has been trained for at least 11 years. Another biomedical professor at PCOM, Jack Springer, M.D., expressed a similar sentiment. "Our healthcare system is absolutely ridiculous."

Sorry, No Tests Left
Lynda Harvey, OMD, L.Ac. (licensed acupuncturist) conducts practice management seminars. She tells the story of a woman who had suffered head trauma and needed an MRI to be sure there was no serious life-threatening complication on the horizon. Her MD had used up his limited allotted number of visual studies (MRI, CT scan) for the month. She had to call around to other MD's to see if any of them had any of their allotted number left. Unfortunately, they did not. This meant that her doctor had to choose: pay out of pocket for the test, or allow the woman to go home in uncertain condition? She went with her conscience, and chose to pay for the test at her own expense.

Why Your MD Can Only See You For 7 Minutes
Dr. Harvey was practicing at the time that some insurance companies began to pay for acupuncture. Many of her patients asked her if she would take their insurance. She let them choose. "If I take insurance, I'll have to hire someone to do all the billing and claims, and because of that, I'll have to see more patients each day, so I won't be able to spend as much time with you as I do now. I may be able to see you only for 10 minutes or so." All but 2 of the patients in her busy practice opted to continue paying out-of-pocket.

Insurance Companies Cut Pay and Inhibit Quality Care
A standard practice of insurance companies is to enlist newly licensed acupuncturists. These new licensees typically have tens of thousands of dollars in debt to pay back to the government, a long practice-building road ahead of them, and, understandably, quite a bit of fear. 'Sign up with us,' the insurance company says. 'We'll give you patients right now!' Unfortunately, their typical pay is quite low, and, if enough acupuncturists accept this lower amount, it will become the standard. As insurance companies try to make greater profits by paying providers less, they increase the stress on practitioners and decrease the quality of care. Motivating people to join an organization by playing on their fear is a cult-like practice. Another possible unfortunate side-effect of insurance companies is that, because they work with formularies (specific protocols for treatment) that may not be based in Oriental Medicine, they may require practitioners to practice in a way untrue to our medicine, and ultimately not beneficial to patients.

The AMA Recognizes a Healthcare Stress Epidemic
The U.S. healthcare system is so bad that the consulting branch of the American Medical Association has written an article titled, '10 Steps To Containing The Health Care Stress Epidemic or How to Get off the Stress Treadmill.' The article reports an 'epidemic level of fear and stress among health care providers and their support staff.' This is because they find they have to work harder and longer hours for less pay. And they're frustrated that they cannot practice medicine the way they want to.

Insurance Collection Wastes Time and Creates Frustration
Al Stone, founder of Acupuncture.com and a Licensed Acupuncturist shares his frustrations with collecting reimbursements (Also at this link, a list of insurance companies that cover acupuncture): "I had a very bad experience attempting to be reimbursed for acupuncture treatments that I performed on two of my patients in 1998. It took me over a year of calls every two months to Aetna. I don't fault them for wanting to make sure that their insured needed the treatments that I performed, but this company was so incredibly beneath my expectations of professional respect and competence... I could swear that had I not continued to call every other month and complain about their slow response that the treatments would have never been paid for. Ever. They simply ignored the process. It was truly amazing. In the end I got paid for some of the treatments and even those, not as much as I should have been paid. The amount that I got paid was actually not as much of a problem as their inability to simply handle the paperwork and get the job done. All they did was sit on the papers, shuffled them around a bit and then ignored the whole process until I called over and over again. As a result of this incredibly silly, time consuming and frustrating process, I do not accept insurance from my patients any longer, rather I give them a super bill and let them seek out reimbursement for the treatments."

Practitioners Opting Out of Insurance System and Succeeding
Timothy Carman, MD, cited two examples: a well-respected MD, and a long-time practitioner of acupuncture, neither of whom take insurance. "They both have waiting lists months long," he said. Consumers are willing to pay for good care. And it's not news that the care given by MD's and chiropractors who take insurance is not satisfying the public.

Healthcare System Broken
As early as 1991, 60% of Americans already believed that their health care system needed a fundamental change. "Of the 10 largest industrialized nations, the U.S. ranked dead last in health care satisfaction, with an approval rating of only 11 percent." source

Insurance companies seem to believe that they are able to provide care that is less 'top-down' if the doctors do not control it. Patients need to have input, they say. I wonder, how can patients get their say if the doctor must see a patient every 7 minutes to make ends meet?

Equally stunning is the problem of capitation. Capitation is one of three standard insurance compensation schemes. The doctor is allocated a specific number of patients (perhaps 1000). The doctor gets paid a certain amount per patient regardless of whether or not he ever sees the patient. That is why, when you call for an appointment, you may end up talking to a nurse who is trying to convince you that your problem is not bad enough for you to come in. This is also one reason why doctors are annoyed by patients with chronic diseases (the other reason being that biomedicine often has unsatisfactory and side-effect-ridden treatments for chronic disease).

Insurance companies and health maintenance organizations have reduced the level of medical care and increased stress for healthcare practitioners.

Alternatives and Solutions:

1.The MSA (Medical Savings Account)

Get your employer to provide an MSA. You can choose your own doctor and change doctors anytime for any reason. There are no deductibles. If you're self-employed, some percentage (it varies) of what you save in your MSA is actually tax-deductible; your insurance pays for itself in tax savings! If you're an employer, look into creating an MSA instead of purchasing a high-deductible major medical policy; your employees will be happier. As for withdrawal of your MSA funds: At anytime the money is withdrawn for medical expenses, it is tax-free. If the money is withdrawn before age 65 and used for non-medical expenses, a 15% penalty will be assessed and will be reported as income. At age 65 monies can be withdrawn without penalty but must be reported as income.

MSA links:

2. Superbills and TOS Discounts

Another alternative is the TOS (time of service) discount. Practitioners can charge a slightly lower fee if the patient pays cash at the time of service. The practitioner can still provide the patient with a superbill which the patient can then submit to their insurance company. Practitioners can combine the ideas of a receipt and superbill (giving every patient a superbill as a receipt) to streamline their office procedures.

The advantage of paying out of pocket for patients is that this empowers your doctor to spend the right amount of time with you, and to choose the best treatments for you. Choose a practitioner that you trust and feel comfortable with, and then empower them to help you by paying them out of pocket.

* Images courtesy of Getty Images

All information herein provided is for educational use only and not meant to substitute for the advice of appropriate local experts and authorities.
Copyright 1999-2001, Pulse Media International