Group Health patients win refunds
Seattle Times staff reporter
Seattle's Group Health Cooperative has agreed to refund millions of dollars to members who were forced to pay for naturopathic, acupuncture and massage-therapy treatments that legally should have been covered by the health plan.
The class-action settlement, which could cost Group Health an estimated $10 million, concludes a series of legal battles triggered by a 1996 state law. The law required parity between alternative-care coverage and general health-care coverage. Three other insurers in the state have already paid out $36.2 million to cover claims and attorneys fees over the past two years.
The Group Health settlement, which could affect 100,000 members, was hailed by alternative-care providers, who have been gaining grudging acceptance from some medical doctors and other traditional healers.
"It's a victory for consumers who want choices," said Jane Guiltinan, dean of clinical affairs at Bastyr University, a natural-medicine and health-sciences school in Kenmore.
Health insurers, led by Seattle-based Regence BlueShield, fought to repeal the so-called "every category of provider" law that went into effect in January 1996. It mandated insurers to pay for covered medical conditions treated by all state-licensed health-care providers on an equal basis.
The law meant that patients could receive approved treatments from a new class of providers — including chiropractors, osteopaths, midwives and certified dietitians and nutritionists — without footing the bills themselves.
Washington is one of only about a half-dozen states that require insurers to provide access to alternative and complementary medicine practitioners.
Insurers had argued that expanding the list of approved providers would drive up premiums. But the state Supreme Court unanimously upheld the law in 2000.
Since then, customers of Regence, Premera Blue Cross and the Northwest Washington Medical Bureau (since merged with Regence) have won separate settlements to reimburse their out-of-pocket costs for alternative treatments beginning in 1996.
The largest amount was a $30.4 million arbitration award in March 2001 to customers of Regence, with $10 million of that going to attorneys. Only $3 million, or 10 percent of the award, was claimed by patients; the remaining $17.4 million is being used to offset premium increases.
Premera's members settled for $2.9 million, or an average of $450 each. The total amount was much smaller than with Regence because Premera, unlike its rival, did pay for alternative medical services but enforced dollar caps and charged higher co-payments, said Rick Spoonemore, an attorney who filed the suits against all four insurers.
Spoonemore estimated that some 100,000 Group Health members may be eligible for refunds. Spoonemore said he hopes to get at least a third of them to submit claims. Regardless of how many people file, the amount of individual settlements would depend solely on their actual expenses.
Keely Barrett, a spokeswoman for Group Health, said the health plan had considered expanding coverage to include alternative medicine even before the 1996 law. Barrett contends that Group Health was in fact compliant with the 1996 law, but said there were many "gray areas" about how and what exactly should be covered.
The law doesn't guarantee patients unlimited access to alternative treatments. Visits to massage therapists, for instance, would require a referral from a Group Health primary-care physician.
Guiltinan, of Bastyr University, said the insurers' reluctance to pay for alternative and complementary medicine stems from sometimes-unfounded fear that they are less effective and would only supplement, not replace, traditional medical care.
Guiltinan said many alternative-care providers are highly trained health professionals who offer added options for patients. Naturopathic doctors and chiropractors, for example, undergo four years of post-graduate medical training.
Naturopaths can perform physical checkups and Pap smears, stitch minor wounds, prescribe antibiotics and provide a host of services that medical doctors do, Guiltinan said. But unlike the latter, naturopathic doctors can't write prescriptions for narcotics or chemotherapy drugs and are barred from admitting patients to hospitals.
Kyung M. Song: 206-464-2423 or firstname.lastname@example.org