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By John Boyle
STAFF WRITER

When your company makes its living off the alternative health care industry, you got to lead by example. At Gaia Herbs in Brevard, that means offering the company’s 100 employees health insurance that covers lot not only conventional doctor's office visits but also trips to the chiropractor, acupuncturist, midwife or massage therapist.

Sounds expensive, bull?

“We were able to save money, in fact, by going this route, because it's more of a preventive care route,” said Pamela Young, human resources manager at the herbal extracts company. “Our health cost actually decreased the last few years, and that enabled us to start other programs, such as short-term disability. From '97 to '98, our health cost decreased 20 percent.”

Not surprisingly, insurance companies play a huge role in the alternative medicine field-mainly because they cover very few of the techniques. Chiropractic coverage is fairly standard, and acupuncture is gaining a foothold as studies verify its effectiveness.

Despite, the lack of coverage, Americans spent $27 billion on alternative approach in 1997, mostly out of pocket. Asheville resident Felicia Berry and her husband foot the bill themselves for their own and their two children's visit to alternative practitioners, often $50 or more per visit. Their insurance provider, like most, doesn't pay for alternative therapies. "It would really be lovely if it were covered by insurance, but we're willing to pay because we're getting what we want," she said.

Most local alternative practitioners simply operate on a cash or check basis, although some who receive referrals from licensed medical doctor, can bill insurance companies. Physicians who practice alternative medicine can file insurance for standard procedures. But doctors like Jim Biddle, a Board certified Asheville internist who does it lot of chelation therapy find they can't get reimbursed for items such as mercury toxicity testing. That means that most of his patients have to pay up front and may not be covered for much of the treatment. And that creates an issue of access - most users of alternative therapies have to have some expendable income.

"There are definitely people who can't come see me because of that," Biddle said. "It has limited the clientele. I would love to be able to take care of lower-income population, but because of this situation they can't afford to pay me out of pocket, or they're on a PPO or HMO and have to pay completely out of pocket. It certainly has limited accessibility to this type of practice." As it stands, just a handful of companies, mostly in the Pacific offer coverage other than chiropractic care. Chiropractic has almost merged into the mainstream of medicine and is a well-accepted technique, particularly for low back pain.

As it stands, 20 million people have insurance that covers some type of alternative coverage, typically chiropractic or acupuncture. The Integrator, a complementary medicine newsletter, estimates that that number will increase to 100 million within three years. Richard Coorsh, spokesman for the American Health insurance Association in Washington, says more than 40 states have a mandate for chiropractic to be covered by insurance companies. A dozen have provision for acupuncture. But of course, it's not that simple. Coorsh says that slightly more than half the people with employer insurance have self-insured plans, which are not regulated by the state. And when your company does offer alternative coverage, you pay for it whether you use alter- native practitioners or not, because the cost is spread to all covered. Besides the cost factor, science is the big sticking point. Coorsh says that by and large good solid research is lacking to offer proof that many alternative therapies actually work. "If the science is there, I'm sure the reimbursement will follow," he said. "The industry is second to none in emphasizing prevention. The issue in this case is different. It's whether there is a consensus in the medical community that any of these procedures are safe, effective and efficacious."

Richard G. Dunn is, betting the franchise that they are. He's the President of a Charlotte company, Alternative HealthCare Option, that hopes to bring alternative care to hundreds of thousands of employees in the Carolinas. Founded in June, the company is a preferred provider organization, or PPO, of licensed and medical acupuncturist, chiropractors, massage therapists, naturopaths, nurse midwives and alternative medical physicians. It also will have a provision wherein subscribers would be reimbursed for their natural drug or herbal remedy purchases. "We don't have any contracts right now but we're in the process of building our network," Dunn said. "We are currently in negotiations with six payers (companies) and it handful of self-funded employer groups, about six, that would like to put alternative medicine onto their benefit structure. We anticipate a half million members by the end of next year in North Carolina, and the way things are going we will match that. There is a considerable amount of interest about what we're doing with the payers."

The alternative plan would go hand-in-hand with an employee's PPO or HMO coverage. The employer would purchase the plan and either offers it as a rider to the regular policy or as part of the core benefits. Dunn estimates the average cost for a rider would be 3 percent of the premium. For an average monthly premium that runs $140 per employee, that would he an additional cost of $4.20 a month. But that's money that the company would easily recoup in reduced medical expenses, he says. Dunn cites the example of treating mild or moderate depression with St. John's Wort instead of Prozac, generating a saving of $70 a month per patient. He also mentioned the JAMA research article that showed yoga to be an effective tool in combating carpal tunnel syndrome, for which the typical claim can run $35,000 in lost time and treatments.

"You can look at it as, 'How much is this going to cost?' " Dunn said. "But the way to look at it is by incorporating alternative medicine into traditional health care you're actually generating a savings." The alternative PPO wouldn't limit visitations, but treatments would have to he medically indicated. In other words, "feel-good massage" wouldn't be covered but medically beneficial massage would be, he said. Dunn acknowledges that a company’s cost may be higher at first as employees entranced by the novelty of the coverage take advantage of it. "We anticipate utilization to be high the first few months after the contract is signed, but after that it will level off," he said. "And health care savings will he realized after that." While he's obviously promoting his product, Dunn believes that insurance companies that offer alternative coverage will "capture the lion's share of the market" while reducing their payout cost. But insurance companies have been slow to jump on the alternative medicine bandwagon, mainly because they want to see hard evidence that the stuff really works. "We are looking at it, but there are a couple of difficulties we have," said Dr. Don Bradley, senior medical director at Blue Cross/Blue Shield of North Carolina, which insures 1.6 million people. "One is finding good literature that really supports the use of some of the alternative therapies. Certainly, the JAMA issue makes a dent in some of that, but still there's really very little information out there. The second issue is making sure people who are providing these set-vices are appropriately monitored and licensed."

Bradley doesn't dispute that some therapies such as massage certainly make people feel better and probably reduce stress. In fact, his company arranges for employees to get chair massages at work for $15. "One could also make the argument for memberships to health clubs," he said. "There are many things out there that could improve your sense of well-being. The question is really whether that should be covered under health insurance."

Dan Denston, executive director of the American Holistic Medical Association in Washington, D.C., believes more coverage is coming and that it will positively impact alternative practitioners. And even though he feels patients' willingness to spend billions on alternative therapies speaks volumes about its validity, he knows that insurance company coverage provides a seal of approval. "People perceive that if insurance is going to cover it, therefore it must have some validity," he said. "Therefore, if it has validity, then we want it."

 DID YOU KNOW

• About 60 million Americans say they have taken botanical supplements, and about 50 million are current users.

• A 1997 Prevention Magazine survey shows that 32 percent of adult Americans frequently use herbal medicines.

• Sales of herbal supplements in 1997 totaled nearly $1.9 billion, up 18 percent from 1996, according to Packaged Facts, a market research firm. Sales are estimated to hit $4.2 billion by 2002.

• In addition to thousands of alternative practitioners in America, about 4,000 medical doctors and osteopaths have studied and use acupuncture in their practices and 500 doctors incorporate homeopathy.

• The U.S. Congress has increased the status and authority of the National Center for Complementary and Alternative Medicine, formerly the Office of Alternative Medicine. Part of the National Institutes of Health, the NCCAM now has an annual budget of $50 million, up from $20 million.

• Also, research supported by the office is moving toward evidence-producing studies. The office has funded 13 research centers at universities and other institutions nationwide that are conducting 50 different research projects.

• About 55 out of 128 U.S. medical schools now offer coursework in alternative medicine.

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