The Oregon Association of Naturopathic Physicians (OANP) last week filed a class action lawsuit in federal court against Health Net Health Plan of Oregon and its contractor, American Specialty Health (ASH), for what are alleged to be discriminatory practices against NDs and their patients in violation of Section 2706 of the Affordable Care Act.
In the words of Dr. Carrie Baldwin-Sayre, OANP's Board President, "Until we have an impact judgment ruling, insurance carriers will continue to skirt the law, and patients and practitioners will be forced to pay the price."
The suit revolves around a patient who saw her ND for a routine preventive care visit in the fall of 2014 and whose insurance claim was subsequently denied. Neither the grievance process nor a letter from the patient’s attorney caused Health Net or ASH to pay the claim.
The suit seeks several remedies, including: reimbursement to the individuals who have been denied benefits; repayment of profits retained by Health Net as a result of its discriminatory practices; enforcement of Section 2706 in the future; and a court order clarifying which practices by Health Net and ASH are unlawfully discriminatory.
Over the past 2 years, AANP, OANP, and other state associations have taken a variety of avenues to prompt compliance with Section 2706. Multiple comments have been filed with the Department of Health and Human Services, discussions have been held with state insurance commissioners, meetings have taken place and complaints have been filed with insurers, yet the vast majority of insurers continue to discriminate against licensed NDs by treating them as out-of-network, classifying them as specialists, capping the number of reimbursable visits, limiting the kinds of conditions that NDs can treat, declining payment for preventive services, restricting access to labs or pharmaceuticals, capping the amount of reimbursement, and reimbursing NDs at rates far less than other licensed professionals providing the same services.
In the words of Dr. Carrie Baldwin-Sayre, OANP’s Board President, “Until we have an impact judgment ruling, insurance carriers will continue to skirt the law, and patients and practitioners will be forced to pay the price.”
AANP heartily congratulates the OANP for pulling together the resources and willpower to build and file this case. Given that progress on other fronts is moving slowly, a favorable judgment here would undoubtedly be a game-changer.