Hawaii Medical Service Association added the first naturopathic doctor to its primary care provider network on July 1, further legitimizing alternative medicine as the popularity of natural therapies continues to grow.

Dr. Landon Opunui, a physician at Manakai o Malama Integrative Healthcare Group and Rehabilitation Center, became the first naturopath to contract with the state’s largest health insurer, paving the way for more alternative medicine providers to join the HMSA network. That means HMSA members with preferred provider organization and health maintenance organization policies will now have the option of choosing a naturopath doctor, or N.D., as their primary care physician. The health plan has about 720,000 members.

“It’s the first time in history this is happening, and there would be no difference for an HMSA member seeing me relative to them seeing any other covered provider,” said Opunui, who has between 250 and 300 patients, most of whom are covered by HMSA. “It would be just the copay (patients pay), just as you’d expect seeing any other physician covered by HMSA.”

Prior to the change, Opunui was viewed as an out-of-network provider, meaning patients would have to pay for services upfront and get retroactively reimbursed a portion of their bill by HMSA.

Americans spent $30.2 billion — $28.3 billion for adults and $1.9 billion for children — out-of-pocket on complementary medicine such as herbal supplements, meditation and chiropractic care in 2012, according to a survey released in June by the National Institutes of Health. That equates to 9.2 percent of all out-of-pocket spending on health care.

“We’re excited to be the first Hawaii health plan to add a naturopath to our primary care provider network,” said Elisa Yadao, senior vice president of consumer experience, in a statement. “Primary care physicians play an especially important role in making sure our members are getting the right care at the right time.”

Naturopathic medicine focuses on natural medical therapies such as dietary intervention, exercise, stress management, nutrient therapy and botanical medicine to heal and improve a patient’s health. N.D.s are licensed to practice medicine after earning a four-year degree from a postgraduate naturopathic medical school accredited by the U.S. Department of Education.

Similar to conventional doctors of medicine, or M.D.s, they can refer patients to specialists, order screening tests, administer vaccinations and manage medications, which would be covered under the health plan. However, herbal medicines and other alternative therapies such as acupuncture and massage are not covered unless a patient pays for additional HMSA complementary care benefits.

“There is not going to be additional benefits for HMSA members; they’re just going to have access to a different type of a provider,” Opunui added. “I may treat blood pressure differently than a medical doctor would and use herbs as opposed to (prescription drugs).”

“It’s all about access to nondrug therapies and giving patients a choice of what type of provider, what type of medical approaches are going to suit them best,” he said. “Prior to this, patients didn’t really have a choice. It was only Western medicine because that was all that’s covered. Now patients have access to alternative medicine and herbs and a greater emphasis on lifestyle medicine.”