What is a Naturopathic Doctor? Can They Practice in Maine? Are They Covered by Insurance?

This article was written by Diane Atwood, a health blogger here in Portland. It can be found here on her blog: http://dianeatwood.com/catchinghealth/what-is-a-naturopathic-doctor/

When my daughter was a toddler back in the mid 80s, one day I noticed that the soles of her feet were all cracked and peeling and red. She was diagnosed with eczema. The treatment was a steroid cream to reduce the inflammation. It didn’t take long to figure out what was causing the problem. Footed pajamas. We thought they would keep her little feet warm and toasty, but instead the plastic materials made her feet sweat. We cut out the feet and she wore cotton socks instead. We also began using Calendula cream, which was prescribed by a naturopathic doctor. Before long, her feet were fine.

I consulted the naturopath — there were only one or two practicing in Maine at the time — because I had recently heard about the field and was curious. Today, there are 30 licensed naturopathic doctors in Maine. One of them is Sarah Kotzur, ND, who practices in Portland and is president of the Maine Association of Naturopathic Doctors.

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Sarah Kotzur, ND

Dr. Kotzur earned her Doctorate of Naturopathic Medicine from Southwest College of Naturopathic Medicine and Health Sciences in 2006. She says many people, including other health professionals, don’t understand a naturopath’s level of education and competency. “They usually think it’s something totally unregulated, without a certain level of education,” she explains. ”That’s our first hurdle. We see healing in a different way. The idea of western medicine is to suppress symptoms or make them go away with medication. With a naturopathic physician, we encourage the body’s self-healing process.”

Homeopathic remedies

Most naturopaths will use a combination of nutrition, supplements and herbal medicine, as well as some physical adjustments to treat their patients. Another tool, which Dr. Kotzur says is one of her specialties, is homeopathy. Homeopathic remedies are highly diluted substances that are meant to trigger the body’s ability to heal itself. The principle behind homeopathy is that you treat “like with like” and so, a chosen remedy would, in large doses, cause the very symptoms a patient is complaining about. In much smaller doses, it would supposedly trigger the body’s ability to heal itself.

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To determine the best course of treatment, including an appropriate homeopathic remedy, Dr. Kotzur spends two hours with a new patient. “I’m trying to know you as a whole person,” she says. “I’m going to ask about what kind of dreams you have, what kind of food you crave. What is your body temperature? Do you sweat? Are you thirsty?”

If you have specific symptoms, she asks even more questions. If you have nausea, for instance. ”Some people have nausea and feel fine when they sit down to eat,” Dr. Kotzur describes. “Some can have no relief of their nausea whatsoever. Others throw up for twenty minutes and feel much better. What you do is ask the patient, ‘What is this experience like for you?  What are the things that give you trouble?’ You get an understanding of their unique set of symptoms and then you find a remedy that matches that set.”

Scope of practice

Some people will only see a naturopath for their health issues, but Dr. Kotzur says most of her patients are also under the care of a medical doctor. “If there are people who are not interested in an allopathic approach to make their symptoms go away and they’re looking for a more holistic approach, then a naturopathic doctor can be on their team to help them with that.”

The problem is, while naturopaths who are licensed to practice in Maine can order laboratory and other diagnostic tests, do physical exams and prescribe some medications, they are limited by a clearly defined scope of practice.

Insurance

Insurance coverage is another issue. Maine Health Policy Analyst Linda Riddell recently answered the following question about coverage for naturopathic medicine in her Bangor Daily News blog Health Unsurance.

“I see a naturopathic doctor for irritable bowel syndrome.  It’s the only thing that works, and I’ve tried everything.  I haven’t had health insurance in years, but I will be getting one thanks to Obamacare.  I’ll be going to the exchange, as soon as it starts working.  Will I be able to find a plan that covers naturopathic services?”

Linda’s answer:

“The two insurers that are offering plans on Maine’s exchange – Anthem and Maine Community Health Options – do not currently cover naturopathic physician services.  Don’t despair yet – you can choose to buy a plan “off exchange”.

First, let’s explain the words.  The exchange is open to people who do not have an employer plan offered to them, AND who qualify for government help (subsidies) to pay for their plan.  In order to get subsidies, a person’s household income has to be less than 400% of Federal Poverty.  For a one-person household, that is $45,960. 

A person who earns more than 400% of Federal Poverty or a person who does not want subsidies can buy a plan “off exchange”.  This simply means that there are no subsidies available.  The “off exchange” plans also have a bit more flexibility and may have more options for you. 

One of your options (outside of the exchange) is a high deductible health plan, also known as a consumer-driven health plan or health savings account compatible plan.  These plans give you a tax-free account to pay for medical services.  Naturopathic medicine can be paid for through these accounts.  (Note: the plan itself may not “count” these toward the deductible, but the tax-free funds are nonetheless available to you.) 

Without a health savings account (HSA) or a flexible spending account from an employer plan, it is fairly difficult to pay for medical expenses tax-free these days.  Under health reform, you have to spend 10 percent of your income on medical care before you can deduct anything. 

You can also encourage your plan, whatever plan you choose, to cover naturopathic services.  If enough people demand it, they may make a change.”

Licensing in Maine

Naturopathy has come a long way since the 1980s. There are currently six accredited schools of naturopathic medicine in the United States and 16 states now offer practice licenses. Maine has been licensing naturopathic doctors since 1996. The Maine statute reads: “A person may not practice naturopathic medicine or profess to be a naturopathic doctor in this State unless that person holds a current, valid license from the board to practice naturopathic medicine.”

– See more at: http://dianeatwood.com/catchinghealth/what-is-a-naturopathic-doctor/#sthash.xHOBfbSd.dpuf