Staking claim Q: Can you tell me why most natural medicine doctors don't accept insurance? Dr. Wright: I know that can be a real pain when you're already paying a significant amount of money for health insurance, and then you're expected to pay more out of your own pocket if natural medicine is your choice for non-emergency health care. But there is a good reason that so many physicians skilled and knowledgeable in nutritional and natural medicine won't process insurance claims: It's because the doctor doesn't want to risk going to jail. Unfortunately, I'm not kidding. In 1996, Congress passed Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996, which you might recognize by its acronym, HIPAA. This law is best known for its so-called "privacy" provisions, which make it incredibly difficult for almost anyone -- including your doctor in many circumstances -- to obtain the least bit of information about your medical records. (Unless, of course, the information is requested by one of the approximately 600,000 individuals or organizations "authorized" by los Federales to obtain your complete medical records without your knowledge or consent. See the April 2001 issue of Nutrition & Healing for details.) But a little-known part of this law declares it fraud to give "medically unnecessary" testing or treatment. It also makes it a federal crime, overriding State authority. And guess who gets to define what's medically necessary or unnecessary? Your insurance company! Over the years, I've seen nearly every medical testing procedure done in natural medicine labeled "medically unnecessary," including, for example, tests for gastric acidity, food allergies, lead, arsenic, mercury and other heavy metals, and gluten-gliadin sensitivity. The list of treatments I've seen labeled medically unnecessary is even longer. It includes saw palmetto for prostate enlargement, vitamin B6 and magnesium for prevention of calcium oxalate kidney stones, vitamin B12 injections for bursitis and fatigue, high-dose intravenous vitamin C injections to speed recovery from viral illness, magnesium injections for relief of spasm -- you get the idea. It doesn't matter if there's ample evidence supporting the test or treatment, or even if the individual improves with natural medicine testing and treatment after years of ineffective conventional testing and treatment. If the private insurance company calls it "medically unnecessary," it doesn't pay. But since HIPAA passed in 1996, private insurance companies can do more than dodge the payments -- they can give the information to los Federales as the basis for criminal prosecution. While that doesn't occur very often, it has happened, and with the ever-increasing persecution natural medicine faces from the mainstream, most physicians who offer it to their patients would rather be safe -- and able to continue providing their patients with natural alternatives -- than sorry. | 
