Several Naturopathic Medicine Patients, Oregon
Naturopathic Medicine. (After Section 2706 went into effect: (Jan 1, 2014)
INSURER(S) / Agency : Health Net Health Plan; American Specialty Health Group
(Note: This account is taken from public reports on the lawsuit filed in Oregon in the summer of 2015 on behalf of patients of naturopathic physicians.)
The first lawsuit based on the provisions of Section 2706 was brought in the state of Oregon by the Oregon Association of Naturopathic Physicians (OANP) in July 2015, on behalf of several patients of OANP members. The suit against Health Net Health Plan and its contractor, American Specialty Health Group, said the firms denied, “…claims for services provided by Naturopathic Doctors (NDs) that are otherwise covered when delivered by a different medical provider.”
One of several plaintiffs, Health Net participant Eileen Fox-Quamme was seen by her ND for a routine preventative care visit, which all insurers are legally required to cover. Her claim was denied. After exhausting Health Net’s grievance process, she submitted an appeal through a Portland law firm. The denial was reversed, on paper: eight months after Fox-Quamme’s appointment, the naturopathic physician who provided her services (even though an in-network provider) had yet to be reimbursed.
“I see an ND for all my primary care,” said Fox-Quamme. “Every insurer covers well-women visits, but Health Net denied that claim because I had it done by a naturopathic doctor. The only reason they even considered reversing the denial was because a law firm submitted an appeal. It is a huge problem if I need a lawyer to access basic, covered benefits.“
According to the OANP press release from which the above information is taken, four other patients had their denials reversed after a law firm submitted an additional appeal.
As reported in the Portland Business Journal, naturopathic physician Jeff Clark noted: “All the major carriers have imposed barriers to access for patients to see naturopathic doctors, even for the same services.” Barriers include limiting how many times a member can see an ND, restricting what conditions NDs are allowed to treat, and paying less for the same service than if it were performed by a traditional doctor or nurse practitioner.
“I’m trying to run a small business and, on average, they’re paying me 20 percent of what they would pay another practitioner,” Clark said.
NDs have been licensed in Oregon since 1928.
Submitted: Sept. 16, 2015
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