Naturopathic Doctors and Patients File Class Action Lawsuit Against Health Net and American Specialty Health
Lawsuit cites unlawful and discriminatory practices that limit access to benefits
The lawsuit addresses years of complaints by NDs and their patients that Health Net discriminates against Oregon licensed naturopathic physicians by denying claims for services provided by Naturopathic Doctors (NDs) that are otherwise covered when delivered by a different medical provider.
The "Non Discrimination in Health Care” section of the Affordable Care Act (ACA), commonly known as "Section 2706” (42 U.S.C. § 300gg-5), prohibits insurance carriers from discriminating against health care providers acting within the scope of their license.
See full press release here.
Donate today - lawsuits are expensive! Please help OANP with a generous donation. This could be a loooooooong process and your help will be critical in getting across the finish line!
We anticipate that this lawsuit could have ripple effects across the country for all naturopathic physicians as well as all other providers who routinely experience discrimination by insurance carriers. Your ongoing support of the OANP throughout this effort could make the difference between business as usual or sweeping changes in insurance coverage.
LEGISLATIVE ROUNDUP 2015
HB 3301 - Creating a Pathway for NDs to be In-Network PCPs -
Many insurers refuse to contract with naturopathic physicians as "primary care providers," instead universally categorizing NDs as "specialists," which cause the following barriers to patient care:
- Higher co-pay & co-insurance for patient
- Denial of payment for preventive services when performed by a ND, including preventive screenings, vaccinations, etc.
- Delay in care or denial of care if the plan requires a referral from a designated "PCP" in order to see a naturopathic physician "specialist."
- Delay of care or lack of care for patients who are not interested in changing doctors or seeing a conventional doctor for preventive services.
HB 3301 gives Naturopathic Doctors who practice primary care in Oregon - and who can meet the insurer's usual contracting and credentialing requirements - the right to choose whether insurance carriers categorize them as "PCP" or "Specialist."
Advocacy Issues OANP Is Following 2015
HB 2468 -
Defines what is an "adequate network" for insurers. OANP worked with the Oregon Insurance Division for all of 2014 to also include provider non-discrimination language in this bill so that our state statutes will reinforce the same language that is in the federal Affordable Care Act.
Vaccines - various bills
OANP worked to ensure that NDs continue to have the ability to educate patients about vaccines and to sign off on medical and non-medical vaccine exemption forms if needed.
HB 3396 -
Consolidates all of the various provider loan incentive programs for working in rural and underserved populations under one umbrella to better evaluate which program is the most successful. OANP has amended the bill to add NDs back into the Primary Care Loan Repayment Program. OANP won inclusion into this program in 2010, then the program was defunded and when it was re-funded in 2013, we were removed from the list of eligible providers. OANP advocated for NDs to be enumerated in the list of eligible providers again. The language was modified to give the Oregon Health Authority the power to enumerate the list of providers, so OANP will continue to work on this during the interim.
SB 231 -
This bill deals with assessing and creating innovative payment methods for primary care. It includes "Naturopathic Physician" in the definition of "primary care provider," an important codification of the scope, training and licensure of NDs.
OANP Urges Naturopathic Doctors & Patients to File Complaints to Insurance Division Urging Insurers to Comply with the ACA
Section 2706 - the
provider non-discrimination provision of the Public Health Service Act as amended by the Affordable Care Act - went into
effect on January 1, 2014. Insurance plans issued on or after this date are now
prohibited from discriminating against naturopathic physicians (or any other provider for that matter) 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.
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