Lower reimbursement rates for integrative providers could be violation of non-discrimination law

A new study shows that the likelihood of health insurance reimbursement for some common clinical services differs significantly depending on whether they are provided by a complementary healthcare service provider or a primary care physician, according to a May 22 press release.

In a comparison of reimbursement rates for health services provided in a non-emergency outpatient setting, researchers found that compared with primary care physicians, the likelihood of reimbursement for any of the services included in the study was 69 percent lower for acupuncturists, 71 percent lower if provided by chiropractors, and 62 percent lower for doctors of naturopathic medicine.

Authors of the article article, "Insurance Reimbursement for Complementary Healthcare Services", James Whedon, DC, MS, Anupama Kizhakkeveettil, BAMS, MAOM, PhD, and Melissa Nagare-Kimura, MAOM, DC, LAC, CCSP, suggest that these differences could affect access to and utilization of integrated medicine services, which could  go against Section 2706 of the Affordable Care Act. known as Non-Discrimination in Health Care.

Nondiscrimination in Health Care requires that insurers include and reimburse licensed health care providers in health insurance plans. It states:

“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.”

This new report could serve as a resource should integrative practitioners experience resistance from insurance companies, according to the press release.

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