Please share with patients!
Insurance Companies May No Longer Discriminate Against NDs
for Same Services - It's the Law!
provider non-discrimination provision of the Affordable Care Act went into
effect on January 1, 2014. Insurance plans issued on or after this date are now
prohibited from treating naturopathic physicians differently from other
providers when the ND is treating the same conditions or performing the same services that the insurer would otherwise cover.
almost a year of OANP working with Oregon’s Insurance Division in advance of this
law going into effect, it appears that the majority of insurers and insurance
plans are in some way still violating this law.
Board has already begun filing complaints.
We need your help too!
Resources in this email:
Link to Complaint Form
Link to Patient Flyer
Sample Patient Email
Sample Facebook Post
Text of Law
What You Can Do
- Encourage Patients to File Individual Complaints - You can Immediately encourage your patients to file complaints with the Insurance Division. Use the tools in the green box above to:
- Send an email to your patients
- Put a flyer in your waiting areas
- Post a message to your facebook page
- Aggregate Complaints from Clinics - Since this is a widespread problem involving thousands of patients, the Insurance Division is creating a form and process for us to file aggregate complaints organized by insurance carrier. The new complaint form for aggregate data should be ready in early March. We urge you to immediately begin collecting data yourselves to be prepared when the new complaint process is initiated for aggregate data.
Create a spreadsheet today with the following information for every claim denial, insurance verification, or reimbursement that seems to be discriminatory. Keep it by your desk or with your billers whenever you do patient benefit verification or claims processing. Collect the following:
- Patient Name, Address & Age (complaints to the insurance division are HIPAA compliant)
- Policy Number
- Insurance Carrier
- Claim Number
- Date of Service
- Type of Insurance (Group Health or Individual Health)
- Details of why you think the carrier is violating the anti-discrimination provision (i.e., annual caps, different deductibles or caps, different copays, denial of service, etc)
- Sign the petition at AANP's www.CoverMyND.org to tell the Governor to ENFORCE THE LAW.
Examples of What Might Be a Violation of Section 2706
of the Public Health Service Act as added by the Affordable Care Act
- Not covering ND services at all, even as an out-of-network provider.
- Applying a $1,000 or other annual cap for services that are identical to those of other providers not subject to this cap.
§ 2706(a) of Public Health Service Act, created by § 1201 of Patient
Protection and Affordable Care Act ("PPACA”) - NON-DISCRIMINATION IN HEALTH CARE.
‘‘(a) PROVIDERS.—A group
health plan and a health insurance issuer offering group or individual health
insurance coverage shall not discriminate with respect to participation under
the plan or coverage against any health care provider who is acting within the
scope of that provider’s license or certification under applicable State law.
This section shall not require that a group health plan or health insurance
issuer contract with any health care provider willing to abide by the terms and
conditions for participation estab- lished by the plan or issuer. Nothing in
this section shall be con- strued as preventing a group health plan, a health
insurance issuer, or the Secretary from establishing varying reimbursement rates
based on quality or performance measures. - 42 U.S.C. §300gg-5(a).