Section 2706 Guidelines in Oregon

It’s time to follow up on my last post. The Oregon Insurance Division finally released the official Section 2706 Guidelines. Here they are, in full:

Public Health Service Act (“PHSA”) Section 2706(a), as added by the Patient Protection and Affordable Care Act, prohibits an issuer of a commercial nongrandfathered group or individual health benefit plan from discrimination with respect to participation or coverage against a provider who acts within the scope of the provider’s license. Section 2706(a) applies to commercial nongrandfathered individual and group health benefit plans issued or renewed on or after January 1, 2014.

The Insurance Division of the Department of Consumer and Business Services (“the division”) will review complaints related to Section 2706(a) on a case-by-case basis under the division’s existing complaint and market regulation framework.

So… what does that mean? On the surface, there isn’t anything new; the guidelines merely states that Section 2706 is the law, and any breaking of the law will be dealt with. However, this is a significant (and positive) change from where things stood last year.

I only touched on it very briefly in this blog post, but last summer the Health and Human Services (HHS) Department had released their own guidelines regarding Section 2706. These guidelines showed a huge misunderstanding of the law itself and its intent, telling insurers that they could implement the requirements of this section using their own “good faith, reasonable” interpretation of the law, and that they didn’t have to accept all types of providers into an insurance network if they didn’t want to.

This wasn’t an accurate read on the law, but because these were the guidelines that HHS had provided, it was what the states were going to follow. That was the starting point of the conversations between the Insurance Commissioner and the CAM provider associations back in October. The fact that the law will now be enforced as it was intended is a huge accomplishment.

Of course, this doesn’t solve all the problems, especially not immediately. No one is going to get a new insurance policy in the mail saying that they now have CAM coverage. And, truth be told, most insurance companies aren’t going to change the way they process claims without some arm twisting. Claims will still get denied for matters involving provider discrimination.

But now we have recourse. Now we can (and are expected to) file complaints with the Insurance Division and point out this discrimination. And you know what? The Insurance Division is on our side. They want insurance companies to follow the law.

I’ve said it before, and now I really mean it: Getting this law enforced is going to take work. And now it’s up to us to do the work.

What can you do (as a CAM provider in Oregon)?

  • Get credentialed. We’re incredibly fortunate to work in one of the few states that allow massage therapists to join up with insurance networks, so we need to take advantage of that. There are a number of insurance companies that will happily accept LMTs into their networks, and there are some that will tell you they are no longer accepting new applicants. Apply to both types of companies, and document what happens if you get denied. I’ll talk more about this in the next blog post.
  • File complaints. If you are already an in-network provider with an insurer, challenge the claim denials you receive. The Insurance Division has a created a special Complaint Form for providers to fill out – you can file all of your complaints in one batch. You can find that form here.
  • Reach out. Tell your coworkers to get credentialed. Ask your cash-pay clients if you can try billing their insurance – even if you know you’ll get denied. Your clients can also register their own complaints using the main Complaint Form, so make sure to pass that along if they’re interested.
  • Communicate. Did an insurance company reject your credentialing application? Did you file a complaint with the Insurance Division? Let us know. Shoot me an email, or let AMTA-OR know (if you’re a member, of course). The more we communicate with each other and across professions, the stronger our case will be.

The future of this law depends on us. We need to do everything we can to make sure it succeeds.