If you’ve recently discovered that your naturopathic doctor, acupuncturist, chiropractor or massage therapist no longer accepts your insurance, you’re not alone. Across Oregon, many patients are encountering the same situation—and the reasons point to a growing access crisis in the state’s integrative and natural healthcare system.
While patients often assume their provider “opted out,” the reality is more complicated. Behind the scenes, reimbursement rates from many insurance companies have been stagnant or declining for more than a decade, while clinics face rapidly increasing operating costs. This mismatch has quietly pushed many holistic and manual therapy providers to drop insurance contracts altogether.
You work hard for your insurance benefits and deserve to right to use them. Your providers deserve to be paid fairly for providing them.
There has been a growing gap between costs and coverage. Since 2013, inflation and overhead costs for healthcare clinics have ballooned—by more than 30 percent in Oregon—driven by higher rent, wages, insurance premiums, medical supplies and administrative expenses. But during the same period, payment rates from insurers for common services such as acupuncture sessions or chiropractic adjustments have barely budged.
This means that each time a provider delivers an in-network treatment, they are often reimbursed at the same rate—or even lower—than they were a decade ago. It’s like being asked to run a clinic in 2025 on a 2013 budget. At some point, the math just stops working.
Additionally, sudden reimbursement cuts have added pressure. In recent years, complementary healthcare providers have faced abrupt reductions in reimbursement with little or no warning. Just months ago, one of Portland’s largest insurers reduced reimbursement rates to complementary healthcare providers by almost 50 percent. (At the same time, another major player in the Oregon insurance market has maintained reimbursement rates at about 50 percent of standard fees for over 15 years.) When a sudden change makes an insurance contract financially unsustainable, clinics must decide whether to shoulder the loss or step away from the contract entirely. For many Oregon clinics, participating in certain insurance networks has become financially impossible.
For patients, these behind-the-scenes financial pressures translate into immediate, noticeable changes—fewer options, less continuity of care and increasing barriers to the natural and preventive therapies they rely on. Many patients struggle to find providers who accept their insurance due to limited in-network options. Obviously, this means longer wait times and fewer options.
Many clinics are moving to cash-based practices or hybrid models with more costs to help manage their budgets. This increases costs for patients and limits access for many.
Patients who rely on insurance to access care for pain management, sports injuries, digestive issues, headaches, women’s health concerns or chronic conditions are finding themselves without affordable options.
Holistic providers have been hit especially hard because, unlike large medical systems, most naturopathic, acupuncture, chiropractic and massage clinics in Oregon are small, independently owned practices. They don’t have the financial flexibility to absorb years of flat or declining reimbursement. At the same time, these providers spend extensive one-on-one time with patients—visits often lasting 30-60 minutes—making low reimbursement especially unsustainable. When payments don’t even cover basic operational costs, participation in certain insurance networks becomes impossible.
Oregon has long been a national leader in integrative medicine, offering patients non-pharmaceutical options for chronic pain, injury recovery and women’s health. As more providers drop insurance networks, the state risks losing ground in areas like opioid reduction efforts, preventive care, chronic pain management and post-injury rehabilitation. When access decreases, patients are left with fewer ways to manage these types conditions safely and effectively. This may lead directly to costlier emergency or specialty care in the future.
If your provider no longer accepts your insurance, ask them why. If the situation is due to insufficient compensation, contact your insurance company to ask for higher reimbursement or better integrative health coverage. While this may seem meaningless, the more feedback they receive the more likely they are to budge.
Next, let your employer’s HR department know that current benefits limit access to non-pharmaceutical care. HR departments shop for insurance and have more bargaining influence then individuals.
Another option is to explore HSA/FSA options for tax-free spending on holistic services. These accounts can be utilized to access care and pay providers fairly.
Lastly, check if out-of-network benefits apply. Many plans will pay you back some portion of your upfront cost.
Erik Isaacman L.Ac
Inner Gate Health & Wellness
InnerGatePDX.com
Editor’s note: Wellness Word is an informational column which is not meant to replace a healthcare professional’s diagnosis, treatment or medication.