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The Merits Were Never Heard

Wednesday, May 24, 2017   (2 Comments)
Posted by: Brook Schales
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Jeff Clark, ND | OANP Legislative Committee Chair

The lawsuit against HealthNet and American Specialty Health(ASH) ran into an unexpected roadblock, and has now been dismissed without reaching a trial on the merits of the case. We are out of court on a technicality.

As you might know, the ND contracts with HealthNet, managed by ASH, are the most egregious any licensed provider might ever consider. They pay NDs well below Medicare rates, and demand a paperwork burden that no other provider type providing general medical care has to bear. We had hoped that this lawsuit would achieve legal precedence that would then be applied to all types of private insurance plans.

Where the lawsuit snagged was on the legal interpretation of “standing,” which is the question of whether someone has a right to sue. The provider non-discrimination provision of the Affordable Care Act was never very clear on how to seek redress in the case of discrimination. At the beginning of the lawsuit, it had been determined that NDs themselves did not have a right to sue themselves, and that only patients who received health insurance through an employer (an ERISA plan) would have a right to sue. The two doctors included on the initial complaint, me being one, were dismissed as plaintiffs at that time. But the patient plaintiffs continued forward with the suit.

In an unanticipated turn of events, the judge in the case recently made the determination that the patient plaintiffs who had their claims denied by HealthNet had themselves not suffered sufficient financial damage to make a legal claim. So she ruled that the patients also did not have a right to sue. We examined all options including appealing that ruling, and determined that there was just no feasible way forward without the plaintiffs incurring substantial financial risk, and the difficult decision to settle the case was made.

Terms of the settlement are neither confidential, nor very exciting. Both sides have agreed to not appeal, or seek any damages or reimbursement from each other for the legal costs incurred up to the point of settlement.

OANP continues to field complaints every week about various insurers denying claims for services when done by an ND. Services they cover for every other provider with a similar scope of practice. And of course there is the issue of pay parity. Routinely insurers will pay NDs between 20-70% of the market rate paid our conventional colleagues for the same services.

We continue to work with state insurance regulators, and have not given up hope that they will eventually waken to action. Whenever you have a claim denial based on your provider type, please email an electronic copy of the insurer’s Explanation of Benefits (EOB) to with a short explanation of the history of that denied claim.

We whole-heartedly thank everyone who contributed their time and money to support this lawsuit. We are all profoundly disappointed, and there is no way to view this dismissal other than as a major setback of our efforts to achieve equitable treatment of NDs and better access to NDs for our patients with insurance.

But now is not a time to quit. Rather a time to reflect, then take a fresh angle on this very fundamental problem facing our profession. The OANP Legislative Committee has already started to lay the foundation for the next legislative steps in our struggle. Be assured: Pay parity is at the top of the list.


Katherine Zieman ND says...
Posted Friday, May 26, 2017
Thank you so much for your efforts. Every little bit counts and will pave the way for those who come after us.
Mary Caselli ND says...
Posted Thursday, May 25, 2017
I would like to thank all who worked so diligently on this cause, particularly Dr. Jeff Clark. The frustration at this outcome is big, but Naturopathic doctors perservere. That grit is what makes us great.

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