Legislature(1995 - 1996)
03/23/1995 01:35 PM Senate L&C
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
Number 412
SL&C 3/23/95
SB 100 DISCRIMINATION UNDER GROUP HEALTH INS.
SENATOR KELLY announced SB 100 to be up for consideration. He said
they are working on work draft 9SLS0788/F4 3/22/95 which changes
the title and deals with including physician assistant and
acupuncturist into the bill.
SENATOR MILLER said he understood there were three groups who were
interested and all three have merits. He thought it was possible
there should be a separate bill for each group.
After discussion with committee members SENATOR KELLY said they
would begin taking testimony and asked Jack Heesch to address the
committee.
MR. HEESCH said he would answer questions.
JONATHAN SCHAEFFER, Licensed Acupuncturist, said that SB 100 would
allow freedom of choice for folks with insurance. This is
basically a fundamental right and a principal that this country was
based on. Acupuncture is a very safe and effective form of health
care for many conditions. In the long run, its use reduces health
costs for consumers and insurers. He supported adding physician
assistants and acupuncturists to the ranks of the reimbursable
health care providers of the state.
RACHEL YATES, Alaska Association of Marriage and Family Therapists,
said she would like to answer any questions they have about
marriage and family therapy.
SENATOR KELLY said that he didn't think that what she did, while
being very important, was medicine. Personally, he thought the
list should just include medical providers.
JERRY REINWAND, Blue Cross, said he thought the committee really
needed to look at the public policy issues involved in light of the
memo from Mr. Koch, Division of Insurance, specifically where he
says 090 (d) isn't a mandate, but then says later that it is a
mandate. He said he was still unclear about that section.
MR. KOCH said perhaps one way to address that question is that if
a policy provides coverage for treatment of a headache, then it
should extend to anyone on the list who can provide treatment for
a headache. If, however, the policy structures itself in a way
that says you're addressing a diagnosis as to what's causing the
headache, then only those people who can make a diagnosis as to
what is causing that headache can be the service providers. He
didn't view this as a mandate of coverage. It is intended to be an
antidiscrimination provision. It says basically, if a provider can
provide a coverage that is covered on a policy and do so within the
scope of his license, then you can't discriminate against him. He
didn't view this as a mandate. He added this would cause some
serious concern for those who don't want to deal with particular
professions.
MR. REINWAND said that answered his question.
SENATOR DUNCAN said he was not sure that was a solution he could
support. MR. KOCH explained if the cause of a backache was beyond
the scope of an acupuncturists' practice, he would be excluded.
The insurer is the one who makes that determination.
SENATOR DUNCAN asked if there was nothing to stop insurers from
just making a policy call on a corporate level denying acupuncture
all together. MR. KOCH replied that if they did that, they would
have to be very careful about how they worded the coverages in
their policy, because as soon as they provided a coverage that was
clearly within the scope of their practice, and allowed another
practitioner to perform it, they would be up against
discrimination. It's not requiring them to provide the coverage,
but it does say that if you provide it, you can't discriminate
against those who can provide that service.
SENATOR DUNCAN asked if adding acupuncturists to this list would
prohibit an insurance contract from specifically excluding
acupuncturists. MR. KOCH replied that it would.
SENATOR DUNCAN asked who decided what is a valid treatment. MR.
KOCH explained that decision goes to the insurer first, and then
a complaint could be filed with the Division of Insurance. The
Division would review what was within the scope of their practice
and, if it's within the scope of their practice, they would go to
the insurer and see why they declined to cover it. The courts can
also determine what's within the scope of the practice of the
acupuncturist.
Number 550
SENATOR DUNCAN said he knew of a case where a physician assistant
provided some services which were within the scope of a P.A. and
provided that service in a physician's office. The physician
submitted a claim to the insurance industry and was denied, because
it was a physician assistant who did it. He asked if physician
assistant were added to the list, could that happen. MR. KOCH said
that that could not occur.
TAPE 95-14, SIDE B
SENATOR SALO asked for his response to Senator Kelly's contention
that these should just be medical providers. MR. KOCH said if a
group health policy structures itself in a way to provide coverages
for things that are not typically within the practice of a
physician or extend to other things, then it may be appropriate.
The policy states what it's intending to provide. If it says
marital counseling and the current list says the only ones who can
provide marital counseling are the psychologist or physician, then
it is limited to just those.
SENATOR DUNCAN said his concern with stating in statute that this
is not mandated coverage, that it would give insurers a loophole to
say they don't recognize that an acupuncturist provides services.
MR. KOCH said he would prefer that language not appear in this
section of law and typically the place where mandates of coverage
are placed are in chapter 42, the section of law that deals with
contract content.
Number 552
SENATOR KELLY announced a break from 2:25 - 2:32.
MR REINWAND said he still thought the effect of 090 (d) was to
mandate coverage. He thought that was a much different policy
question than adding people to the list. He thought it would be
helpful for the committee to clarify the statute does not mandate
coverage.
Number 535
LINDA REXWINKEL said her concern was with acupuncture. She said
she suffered from a chronic pain syndrome called reflex sympathetic
dystrophy which she contracted in 1991. Basically, the sympathetic
system in her leg has gone crazy and produces pain on its own
initiative in the form of swelling which cut off her circulation,
and if left untreated, her leg would gangrene and require
amputation. She had no alternative, but to secure medical
treatment which has amounted to about $65,000 since 1991. The
normal course of treatment for this disorder by the medical
profession is an injection of anesthetic which did not work for her
at all. Since 1993, she has seen Suzanne Cortright, an
acupuncturist here in Juneau. The average cost for the medical
treatment that didn't work was about $1,000. Ms. Cortright's
treatments are just a fraction of that and the amount of pain
relief is substantial. For many people with chronic pain,
alternative medicine is about the only course of treatment they
have available to them, because the regular medical profession does
not fully understand what is happening and can't provide relief.
As an employee under the state's plan, her acupuncture was not
covered by Aetna Health Plans. She thought she faced unfair
discrimination, because she knows people who had acupuncture
treatments by physicians who were covered by Aetna.
It, therefore, seems to her that we have occupational licensing for
various professions, but do not accord them the same kind of
treatment as we would an M.D. It seems we allow for coverage of
services by a doctor merely because he has an M.D. behind his name,
even though he made not have had any specific kind of acupuncture
training and merely has someone else administer the needles for
him.
She said the cost of the treatments between the two would be much
less for the acupuncturist. The issue is not only of fair coverage
and discrimination, but to provide people with an alternative to
traditional medicine when it doesn't work, and to be able to
receive reimbursement for it, and also cost containment.
SENATOR KELLY said he was in favor of the lower cost, but it seems
that they are adding to the list, but no one is saying you only get
one of these, so he wondered if there really was any savings in the
final analysis.
MS. REXWINKEL said she thought there was a cost savings, because
people go to whomever their insurance covers. If the alternative
is provided, people can go to whomever they want. She did not
believe putting acupuncturist in there makes it a mandated service.
From when she sold insurance, she recollects that insurance
companies have the ability to make discretionary changes in the
policies in the coverage they provide. She asked why they wouldn't
want it covered, if they are already paying for it under an M.D.
and providing alternatives to people is one way to control cost.
SENATOR DUNCAN asked why Aetna turned her down. MS. REXWINKEL said
"service not covered." She said she didn't realize they were
covering acupuncture by a physician in Anchorage until just
recently. She has drafted a letter to Aetna and Division of
Retirement and Benefits detailing the fact that they are paying for
services under a physician in Anchorage, even though they are not
paying for her acupuncturist down here.
MS. REXWINKEL said her experience with Aetna is that many times it
is the initial claims representative, then the claims supervisor,
and then it would be a nurse who reviews the file and makes the
determination on what is covered.
An appeal goes to the Division of Retirement and Benefits who
review Aetna's denial and then the courts are beyond that.
Number 427
BOB STALNAKER, Director, Division of Retirement and Benefits, said
he had a neutral position on SB 100. He said in the case of an
M.D. using acupuncture for treatment modalities, they would have to
check that out.
SENATOR SALO said she didn't think it was unusual to go to a
medical doctor, a chiropractor, acupuncturist, or a massage
therapist, or whoever to find a solution to your condition. She
asked how that was handled under the Aetna system. MR. STALNAKER
said he thought that situation would be very rare, and people
normally switch providers within the same professional service.
SENATOR SALO said she disagreed, that she personally knows people
who seek many different kinds of health care, especially when you
think of chiropractic services in addition to a medical doctor.
MR. STALNAKER noted that the insurer would eventually deny coverage
after a point in time, because of improper treatment.
SENATOR DUNCAN asked him if he agreed with Mr. Koch's position,
that if there is a service specifically covered by Aetna, as in Ms.
Rexwinkel's case, and she goes to a physician, they pay the claim.
If she goes to an acupuncturist for that condition, Aetna would
have to pay the claim also. MR. STALNAKER said that would be
correct if acupuncture services were an accepted form of treatment
for that ailment.
Number 375
SENATOR DUNCAN asked who makes the determination of what's an
accepted form of treatment for that condition. MR. STALNAKER said
the decision is made by the insurance carrier through generally
accepted treatment modalities, the "treatment book."
SENATOR DUNCAN asked if the state had any ability to have impact on
that. He said he really didn't have too much faith in getting non
traditional services covered, because Aetna corporate headquarters
could just say they don't accept that as a form of treatment for
that particular condition. He didn't see what good it did to have
anyone listed, if the state is leaving it up to the insurance
industry to make the decision about what are accepted forms of
treatment.
MR. STALNAKER said there will always be treatments that are not yet
medically accepted forms of treatment that over time might become
accepted. SENATOR DUNCAN said, in reference to Ms. Rexwinkel's
condition, that it was a "fringe condition" and he wanted to see
the book that Aetna uses for these determinations.
MR. STALNAKER responded that "the book" defines what's an
acceptable treatment rather than who is acceptable to do it. If an
acupuncturist is licensed to perform that form of treatment, they
would be reimbursed.
SENATOR DUNCAN said he didn't understand what an acupuncturist's
license says.
Number 300
SUZANNE CORTRIGHT, Acupuncturist, read the statute definition of an
acupuncturist: "A form of healing, developed from traditional
Chinese medical concepts, that uses the stimulation of certain
points on or near the surface of the body by the insertion of
needles to prevent or modify the perception of pain or normalize
physiological functions. The practice of acupuncture means the
insertion of sterile acupuncture needles and the application of
moxibustion to special areas of the human body based upon
acupuncture diagnosis. The practice of acupuncture includes
adjunctive therapies involving mechanical, thermal, electrical, and
electro-magnetic treatment and the recommendation of dietary
guidelines and therapeutic exercises."
MR. STALNAKER said we pay to have medical experts make those kinds
of calls. He felt they would do it without discrimination and with
a completely open mind in what is generally accepted in the medical
profession. He said acupuncture is allowed as a form of
anesthesiology. SENATOR DUNCAN commented that the insurance
industry can hire doctors to give opinions like he can hire an
attorney to give him an opinion.
Number 290
MS. CORTRIGHT presented a list from the World Health Organization
of things that are acceptable for treatment by acupuncture. She
said insurance coverage for acupuncture increases the efficiency of
our health care system. By beginning treatment with the least
invasive and least expensive modalities there will be less money
spent overall. She said that often her patients have been through
months or years of medical treatment that was quite costly and
ineffective. Acupuncture often provides relief for them at a small
fraction of the cost. If it were covered by insurance, it would
provide encouragement for people to seek these less expensive
modalities earlier. She said that acupuncture is very effective
for addictions.
SENATOR TORGERSON asked if her treatment just made people feel
better or if it really cured them too. MS. CORTRIGHT said
absolutely; the goal is to get people better so that they don't
come back. She noted that some insurance companies cover
acupuncture (in pilot programs), like Blue Cross and Blue Shield of
Washington and Oregon, and they are saving money.
Number 211
MS. YATES wanted to point out that marriage and family therapists
are licensed providers of a clinical service in this state. They
are mental health providers and however you describe that, it is
more or less medical. Marriage and family therapy is regularly
mandated to clients in the state via the judicial system and the
Division of Family and Youth Services. They seek to repair
relational difficulties within the family system.
JUDITH FROST said she took time off from work to testify, because
she feels strongly about this issue. She said acupuncture has been
much more effective than any other alternative she has tried for
her sleep disorder and depression from the death of her daughter.
She tried traditional medical treatments and became addicted to
valium. She then started going to Suzanne Cortright for
acupuncture treatments and found that it was most effective for
dealing with her condition.
She works for a company that does cover acupuncture. She feels
strongly that everyone should be able to have their insurance
coverage pay for acupuncture treatment.
SENATOR DUNCAN asked what insurance company she used. She replied
it was Northwestern.
SENATOR KELLY said the committee would take into consideration the
testimony heard and bring the bill up at a later date.
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