Washington's "Every Category of Provider" Law Upheld Again
By Editorial Staff
Group Health Cooperative, a Seattle, Washington-based insurance provider, has settled a class-action lawsuit by agreeing to reimburse members for money spent on visits to acupuncturists, massage therapists and naturopaths from June 1, 1996 through December 31, 2002.
Members will be reimbursed for the full amount paid per visit during that time period (minus an $8.65 copayment).1
In addition to reimbursement, the settlement gives current Group Health members the ability to seek acupuncture and naturopathic treatment for any condition, for up to five visits per year, without prior referral from a Group Health doctor. After five visits, a patient may continue to receive acupuncture after obtaining a referral.
The settlement stems from a class-action lawsuit that accused Group Health of illegally requiring that members exhaust medical treatment before receiving treatment from acupuncturists and other alternative care providers. Washington's 1996 "Every Category of Provider" law requires insurers to cover services provided by all of the state's licensed categories of health care providers on an equal basis.2
Group Health touts itself as "the nation's second-largest consumer-governed, nonprofit health care system," providing coverage for approximately 585,000 of the state's nearly 6 million residents. It is the third major insurer to settle following alleged violations of the 1996 law, joining Premera Blue Cross, which settled for $2.9 million, and Regence Blue Shield, which settled for $30.4 million.2,3
In a prepared statement, Group Health noted that it would be making changes to its alternative care benefits "similar to those made by [the] other insurers."1
According to Rick Spoonemore, attorney for the law firm that represented Group Health members in the suit, the settlement has been granted preliminary approval in state and federal court, with final approval to be sought in June. Spoonemore also noted that while only approximately 10 percent of the nearly 1 million people covered by Group Health from 1996-2002 are eligible for reimbursement, the total dollar value the insurer may end up paying may reach as high as $10 million.4
Claimants have until June 19, 2003 to apply for reimbursement. Further information and claim forms are available at the AltCareLaw Web site (www.altcarelaw.com).
Group Health settles "alternative care" lawsuit. Puget Sound Business Journal, Feb. 11, 2003.
Group Health patients win refunds. The Seattle Times, Feb. 12, 2003.