When Bangor mother Marie Schramke and her husband were looking into primary care physicians for their 3-year-old son, they found themselves drawn to naturopathic doctors. Schramke had seen one while she was pregnant in 2011, and enjoyed the well-rounded, personal experience.
She and her husband felt a naturopath’s approach to health was fundamentally different than mainstream physicians, and more aligned with their health care goals.
“Naturopathic doctors blend science and nature, they treat the whole person, not just the symptom,” Schramke said. “There is a true partnership between caregiver and receiver.”
But there was one problem: the provider they chose wasn’t covered by the Schramkes’ insurance. In fact, no naturopaths were, so they found themselves paying out of pocket and deciding to only have their son see her, instead of their entire family.
“My husband and I cannot afford to pay as much as $5,000 for all of us, so we prioritized sending our son … and [we] are very happy that we did so,” Schramke said.
But a group of naturopathic doctors in Maine is trying to change that and help more families and individuals throughout the state have access to more care options.
Required care
According to Section 2706 of the Affordable Care Act, insurance companies cannot discriminate against providers who are licensed or certified under state law. In Maine, naturopathic doctors must pass the national naturopathic licensing exam and earn an additional state license. Therefore, they fall under the act’s non-discrimination policy. They can prescribe antibiotics, give vaccinations, offer holistic and natural remedies and do wellness examinations, among other medical procedures.
However, Anne Jacobs, a naturopathic doctor practicing in Newcastle and a member of the Maine Association of Naturopathic Doctors, said only one Maine health insurance company is currently in compliance. She and others were told by the state insurance commission earlier this year that it was their responsibility to work directly with health insurance companies and request compliance, but that has been difficult.
“I think they’re playing the numbers game. There’s not enough of us and we don’t have enough money to sue them,” Jacobs said.
The insurance commission did not return requests for comment for this story.
Insurance company Maine Community Health currently considers naturopathic doctors “specialists,” meaning customers can see them, but are charged differently than if the doctors were considered primary care physicians. So patients seeking care covered completely under the ACA, like well-woman or well-child exams, are not covered if they see a naturopath, which is frustrating for doctors like Jacobs.
“We’re not specialists or an alternative. We are the doctor that people can see for all of their health care needs,” Jacobs said. “People in Maine in general tend to think of naturopathic doctors as their primary care provider. We can bring the gap between western medicine and provide a more holistic approach.”
It’s that approach that led Brooke Plourde Dupuy, a mother of two, to consider naturopathic care for her girls, ages 4 years old and one month. However, she hasn’t booked an appointment. Her insurance is among those that don’t cover naturopaths, so she would have to pay out of pocket, something she’s not willing to do.
“I don’t have specific conditions in my girls that I’d like to seek care for, I just want to set them down the path to wellness,” Plourde Dupuy said. “I have insurance, so I don’t think too much about cost when I’m looking for care, but I would not go to a provider if it wasn’t covered.”
The next step
Tired of hearing from individuals and families like the Schramkes and Plourde Dupuy, Jacobs and others have hatched a plan to pressure the commission and Maine insurance companies to comply. They also submitted a letter to the U.S. Department of Health and Human Services about their attempts to implement Section 2706 in Maine.
Starting Oct. 6, the first day of the national Naturopathic Medicine Week, naturopaths around Maine will have addressed postcards for patients to use to send letters to the insurance commission and governor’s office encouraging compliance with Section 2706.
“We want to say, ‘Here are all the Mainers who aren’t being covered,’” Jacobs said, adding that the association is also encouraging specific patients to send letters if they were denied naturopathic care. “By law, the commission is required to follow up on denials of care, so this is a two-pronged campaign.”
In the meantime, Jacobs will continue seeing her patients and asking for payment at the appointment. And while she knows that many are frustrated, she’s confident her patients will continue seeking the care they believe in.
“Mainers always make their own decisions, they decide what works for them,” she said. “They don’t care what their neighbors are doing, they are willing to travel or pay out of pocket for the health care that’s going to be best for them or their family.”
