For Oregon Providers

Are you an LMT in Oregon? We need your help!

The Provider Non-Discrimination Provision (Section 2706) of the Affordable Care Act went into effect on January 1, 2014. Insurance plans are now prohibited from treating massage therapists differently from other providers when the LMT is performing the same services that the insurer would otherwise cover.

After almost a year of Oregon’s Insurance Division working together with several CAM groups in advance of this law going into effect, it appears that the majority of insurers and insurance plans are in some way still violating the law.

CAM providers in the state have already begun filing complaints with the Insurance Division. We’re fortunate enough to work in one of the few states that allow massage therapists to take part in insurance networks, so we need to assist with the process.

How can you help?

  1. Encourage your clients to file complaints with the Insurance Division. If their policy is discriminating against LMTs (see below for examples), that means their policy is in violation of the law. They should fill out the Consumer Complaint Form on the Oregon Insurance Division website. I’ll provide more details about this later.
  1. Aggregate complaints for multiple clients. Since this is a widespread problem involving thousands of patients, the Insurance Division has created a form for LMTs to fill with all of their claim denials, insurance verification, or reimbursements that seems to be discriminatory. Download the Provider Complaint Form here.
  1. Not credentialed? Learn about how to join insurance networks here. Does your client’s policy discriminate against LMTs who are working out-of-network? You can still use the same Complaint Form.

Examples of What Might Be a Violation of Section 2706 
of the Public Health Service Act as added by the Affordable Care Act: 

  • Not covering services performed by LMTs at all, even as an out-of-network provider.
  • Applying a $1,000 or other annual cap for services that are identical to those of other providers not subject to this cap.
  • Applying treatments to a different “alternative care” cap instead of applying it to the plan’s normal deductible.
  • Refusing to pay for a massage performed by an LMT, when it would be covered when done by another provider.
  • LMT is in-network with insurer but some plans offered by insurer deny coverage of services by LMT.
  • Reimbursement rates for same quality and performance of services done by an LMT are substantially different for LMT than for other providers.

Text of the Non-Discrimination Law:

§ 2706(a) of Public Health Service Act, created by § 1201 of Patient Protection and Affordable Care Act (“PPACA”) – NON-DISCRIMINATION IN HEALTH CARE.

(a) PROVIDERS.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures. – 42 U.S.C. §300gg-5(a).

One thought on “For Oregon Providers

  1. Pingback: Trigger Point Massage Therapy Portland Oregon - Natalie Weintraub, LMT » Essential Health Benefits

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