Oregon naturopaths sue Health Net, allege discrimination

A group of Oregon naturopathic doctors and their patients have filed a class action lawsuit in federal court against Health Net Health Plan of Oregon, alleging that the insurer arbitrarily denies payment for primary care services provided by naturopaths.

At least five patients have hired a law firm to appeal denials by Health Net on medical services provided by naturopaths, according to the Oregon Association of Naturopathic Physicians.

In one case, Eileen Fox-Quamme received her well-woman exam from her naturopathic doctor, and she has had to exhaust the insurance company’s grievance processes and finally file an appeal through a law firm.

Eight months later, the doctor still has not received payment for the annual preventative screening visit, according to the association.

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.

Health Net also puts a dollar cap on patients’ access to naturopathic services, requires a “Medical Necessity Review” form that other practitioners aren’t required to provide and reimburse naturopathic doctors at up to 80 percent lower for the same services provided by other types of providers, according to OANP.

Lori Rieger, communications manager with Health Net, declined to comment for this story.

Matt West, a naturopathic physician in Salem, said he’s used to the complicated nature of health insurance, but said Health Net is particularly “atrocious.”

He still participates in their network because a large group of his patients have Health Net.

“Most naturopaths don’t get on Health Net’s panel, because it’s such a pain, and their reimbursement rates are atrocious,” he said.

Much of the alleged discrimination stems from ignorance about naturopaths’ training and licensure, West said. Naturopathic medicine isn’t just about herbs and it’s not unscientific, he said. Instead, naturopaths look for ways to treat patients in the least invasive way possible. They also spend more time with patients, focusing on the whole person and their environment, rather than just their symptoms, he said.

The lawsuit seeks reimbursement to people who have been denied benefits under Health Net, repayment of profits that were a result of the alleged discriminatory practices, enforcement of future nondiscriminatory acts and a court order that clarifies which of Health Net’s practices are unlawfully discriminatory.

About 750 naturopathic doctors practice in Oregon, according to OANP.

syoo@StatesmanJournal.com, (503) 399-6673 or follow at Twitter.com/syoo.