Providers and patients have filed complaints to the state insurance division as well as to the Department of Labor. Eight months after Fox-Quamme’s Novemmedical visit, the in-network Health Net naturopathic physician who provided her medical services has yet to be reimbursed by Health Net or its subcontractor ASH.Īdvocates have been working directly with federal agencies and state insurance commissioners for the last two years to implement and enforce the provider non-discrimination provision to little effect. To date, four other patients had their denials reversed after a law firm submitted an additional appeal. ![]() It is a huge problem if I need a lawyer to access basic, covered benefits.” The only reason they even considered reversing the denial was because a law firm submitted an appeal. “Every insurer covers well women visits, but Health Net denied that claim because I had it done by a naturopathic doctor. ![]() “I see an ND for all my primary care, including my annual well woman exam last October,” said Fox-Quamme. One month later, she received a letter from Health Net stating that while her claim had been correctly denied by ASH, ASH recommended that Health Net should consider paying the claim through its normal medical benefit regardless. After exhausting Health Net’s grievance process, in February 2015 Fox-Quamme submitted an appeal of the denial through the law firm Bennett, Hartman, Morris & Kaplan. Health Net’s subcontractor ASH, which provides contracting and claims processing for all Health Net “complementary providers,” including naturopathic doctors, denied her claim on November 4, 2014. On October 27, 2014, a Health Net-contracted naturopathic physician saw Fox-Quamme for a routine preventative medical care visit, a service that all insurers are legally required to cover. Lawsuit plaintiff and Health Net participant Eileen Fox-Quamme experienced the medical care limitations caused by Health Net’s discriminatory practices first-hand. § 300gg-5), prohibits insurance carriers from discriminating against health care providers acting within the scope of their license. The “Non Discrimination in Health Care” section of the Affordable Care Act (ACA), commonly known as “Section 2706” (42 U.S.C. The lawsuit was filed on behalf of naturopathic physicians and their patients who allege 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. (Health Net) and their contracted benefits provider American Specialty Health (ASH), alleging unlawful and discriminatory practices. ![]() PORTLAND, ORE., J–Today, the Oregon Association of Naturopathic Physicians (OANP) filed a class action lawsuit in federal court against Health Net Health Plan of Oregon, Inc.
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