Blue Shield to cover 'alternative' heart treatments.

Policy to cover up to $5,000 worth of health sessions

Blue Shield of California is the second major insurance company in the nation to approve coverage for intensive lifestyle programs to prevent surgery for patients with heart disease.

The lifestyle program includes long-held medical support on the importance of diet, nutrition, exercise and smoking cessation in preventing heart disease.

"We've been studying this sort of therapy for some time and have done extensive review of published clinical data and research before we reached our decision," said Mike Odom, a spokesman for San Francisco-based Blue Shield, one of the nation's largest providers of health coverage and managed care programs.

He said the lifestyle program is not an endorsement of experimental or unconventional treatments because programs to change a person's lifestyle have been in existence for a long time.

"What appears to be unconventional is that this is one of the first times a major insurance company is recognizing this form of treatment in terms of covering it as a contractual benefit," he said.

The program is open to 1.6 million Blue Shield members who have a history of coronary heart disease and are candidates for some form of heart surgery, Odom said. The program does include enrollees on Medicare, which is government subsidized insurance for the poor and disabled.

Blue Shield's new policy would provide coverage for up to 36 lifestyle program sessions at a total cost estimated at between $3,500 and $5,000.

The unveiling of Blue Shield's new program comes just a few months after Mutual of Omaha Insurance Co.'s July 27 announcement that it would reimburse its members for costs incurred on alternative treatments for heart disease.

Mutual of Omaha, which provides coverage for about 10 million members, approved coverage for a therapy which uses a vegetarian diet, exercise, meditation and support groups to combat heart disease. That therapy was developed by Dr. Dean Ornish, an internist and director of the Preventive Medicine Research Institute in Sausalito. Ornish's program is the only "alternative treatment" covered by Mutual of Omaha.

Blue Shield's program, however, is not inclusive of just one therapy, said Odom.

He said Blue Shield will reimburse any lifestyle program that is approved by its Medical Director, Dr. Wade M. Aubry. To be eligible for coverage under Blue Shield, the lifestyle programs must be proven to be clinically effective.

One of the few programs that has been approved by Blue Shield so far was started by Dr. Harold Karpman, a clinical professor of medicine at UCLA's School of Medicine and founder of the Cardiovascular Medical Group of Southern California in Beverly Hills.

In his program, Karpman said, heart patients typically meet two nights a week for four hours, during which time they walk with an exercise physiologist, do yoga, meet in groups to learn about changing behavior and learn how to prepare vegetarian meals.

"In motivated patients, this is a superb method of therapy," he said. As evidence of the therapy's effectiveness, Karpman cited the experiences of some patients who had undergone two bypass operations and had been on a steady diet of prescription drugs. Because their condition improved so dramatically with lifestyle changes, the patients were able to completely discontinue the drugs, he said.

In addition, he said, the program makes "enormous sense" economically.

Patients who vigorously follow lifestyle change programs costing about $5,000 may be able to avoid incurring the $30,000 cost of a bypass surgery, he said.