A class-action suit has been filed in federal court alleging the insurer is improperly denying coverage.
BY JACOB PALMER | DIGITAL NEWS EDITOR
A class-action suit has been filed in federal court as naturopathic doctors and patients allege Health Net Health Plan of Oregon is improperly denying coverage.
The complaints revolve around a provision in Obamacare.
Under the Affordable Care Act, insurance companies are required to cover one annual physical per year, without cost sharing and before the deductible is met. However, some insurance companies don’t recognize naturopaths as primary care doctors.
In addition, the lawsuit alleges that Health Net violates a provision of the Affordable Care Act that prohibits insurers from discriminating against health care practitioners who practice within the scope of their license. Oregon naturopaths are licensed and trained to practice primary care, prescribe medications and order tests.
(SOURCE: Statesman Journal)
The plaintiffs allege the insurer of discriminatory practices by not adhering to the mandates of the ACA.
“This requirement prohibits covered health benefit plans from discriminating against health care providers, if those providers act within the scope of their license of certification,” the suit says. “Numerous studies have shown NDs to be effective at treating a wide range of ailments, preventing disease, providing cost-effective care and improving overall life satisfaction.”
Health Net didn’t cover certain services within the scope of an ND’s license, such as various diagnostic tests and imaging, the suit alleges. The insurer placed an annual limit on the number of reimbursable ND office visits, while imposing no similar limits on office visits to other medical practitioners for the same services, according to the suit.
(SOURCE: Portland Business Journal)
Elieen Fox-Quamme, of Gresham, is at the center of the case. After being told a well woman checkup would not be covered, she said that she “was not willing to let it slide. I’m putting my foot down.”