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Insurance coverage spotty for integrative medicine

By Ira Zunin

LAST UPDATED: 11:37 p.m. HST, Aug 5, 2011

Integrative medicine is about bringing together the best of modern medicine, traditional healing arts and manual therapies. With a view toward prevention and education, and a priority placed on cultural values and healthy lifestyle choices, this field aims to treat the patient as a whole person using a collaborative approach. Integrative medicine is also about using a bigger toolkit composed of a team of health providers who are not limited to medical doctors alone. The integrative clinical team might include psychologists and physical therapists, professionals typically covered by health insurance plans. It might also include health providers that are not routinely covered by insurance.

In the past six columns on the Wealth of Health, we have addressed multiple aspects of our complex insurance industry. Many readers have written in asking, in particular, about available insurance coverage for health services other than physician care.

The state of Hawaii delegates the management of professional licensure to the Department of Commerce and Consumer Affairs. Its role is to establish scopes of practice and standards of care, and it may become involved in disciplinary action. Its primary charge is public safety. It houses, for example, the Board of Medical Examiners. The DCCA also houses licensing boards for four health professions that might be found on an integrative team: acupuncture, naturopathy, massage therapy and chiropractic.

All four of these professions may be accessed by residents of Hawaii as follows:

» Workers' Compensation: acupuncture, chiropractic, massage therapy and naturopathy
» Auto/PIP: acupuncture, chiropractic, massage therapy and naturopathy
» ASHNET Kaiser/HMSA: acupuncture, chiropractic, massage therapy and naturopathy
» UHA: acupuncture, chiropractic and naturopathy
» Medicare: chiropractic

While the above appears to reflect robust coverage, access is not as comprehensive as it seems. Based on PIP (personal injury protection) legislation in the 1990s, acupuncture, chiropractic and naturopathy are limited to a fixed reimbursement of $75 per visit. This rate has never been adjusted for inflation. To some degree, workers' comp insurance has followed suit. Also, under PIP coverage, the combined number of visits for acupuncture, chiropractic and naturopathy may not exceed 30. The ASHNET rider for HMSA and Kaiser offers only limited reimbursement and typically requires substantial administrative time. Coverage under UHA and HMAA also offers relatively low reimbursement and is seen by some more as a marketing tool than genuine coverage. Medicare coverage for chiropractic is so low that few providers accept it. Neither HMSA nor Kaiser offers any of these services as a core benefit.

No health profession, not even conventional medicine, is a panacea. Every profession must be accountable to a clear and reasonable standard of care, and a scope of practice informed by scientific evidence and supported by proper education. In the end, public safety is best served when the people of Hawaii have access to all forms of reasonable and appropriate care, care that brings together the best of modern medicine and traditional healing arts.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to

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