US Health Care Is Completely Controlled By A Cabal That, Itself, Controls The Department Of Health And Human Services (DHHS)…

But, President Trump Can Fix This By a Signature On An Executive Order…

The Bolen Report has championed real health care reform, publishing a series of break-through articles about how President Trump can save health care in America. In this article we look at insurance reimbursement for integrative services and how the President can lead health care from the swamp.

By Ralph Fucetola JD

One big step toward the needed reforms would be for Health Insurance Companies to pay for cost-effective holistic and integrative services, rather than suing doctors who offer such services.

The premium-paying public wants access to “alternative” services but the insurers refuse, in violation of the Provider Nondiscrimination provisions of existing law.

The good news is that a pending law suit here in New Jersey may just fix that.

I have been working closely with an integrative practice in New Jersey for years helping them stand up to the state medical board and Health Insurance Companies as their practice has been harassed since 2012.

By the way, since this practice first opened in 2002, not one patient has ever filed a complaint.

When the state medical board and the largest insurer in the state set their sights on an alternative medicine practices, they usually shut the practice down. This is because most alternative providers can’t afford a multi-year a legal defense.

However, with some support from folks like you, a judge just ruled against the Health Insurance company as it asked the judge to grant judgment in its favor without going to trial. The law firm handling this case says it doesn’t know of another example where a small provider survived this type of Summary Judgment attack!   

The billing coding system itself is run by the American Medical Association, on contract with DHHS, which profits from its use.

If there are no billing codes for holistic or integrative therapies, then there can be no reimbursement.  And, officially, there are no codes….

Providers can get “creative” with their coding, but then they face ruinous litigation. In the NJ case the providers never sought reimbursement for the therapies, such as vitamin drips, but only for the IV medical services, which cost far more than the therapies themselves. [1]

Now things get a little tricky here. The insurers are part of the control system alluded to in the headline above. They only reimburse if the health care provider uses the “correct” insurance code or CPT code.

So, ask yourself “Why are there no direct insurance codes allowing coverage for the natural therapies the premium-payers want? “

President Trump can change all this with his signature on an Executive Order requiring HHS to allow such coding.

The necessary coding has been developed by concerned professionals, but is blocked by the AMA/DHHS control system.

The President can force through the needed reforms to allow reimbursement for holistic and integrative therapies.

The Affordable Care Act, Section 2706(a), prohibits insurers from discriminating against healthcare providers who are acting within their legal scope of practice.

Health insurers are saying it doesn’t have to cover alternative medicine, even though it is being delivered by an MD, or advanced practice nurses and a Naturopath working under the doctor. What this means is that this case may be a proper vehicle to test the extent of the law’s “provider nondiscrimination” clause — this case may set a precedent forcing insurers to cover holistic and integrative care!

You can help set an important legal precedent with a small donation to put insurers on notice that the courts are going to require them to obey the law and cover holistic and integrative care!

Small donations from large groups of consumers and providers will help assure more people have access to alternative medicine and show insurers that harassing providers through the legal system is less attractive to them.

As little as $5 can help assure that health insurers are forced to comply with Section 2706 of the ACA which 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.”

We strongly believe that getting this case before a jury will prove not only that BCBS and the State Medical Board are discriminating against this practice but that this law cannot be ignored by carriers without consequences.

By supporting this case, consumer access to holistic MDs, DOs, advanced practice nurses, chiropractors, acupuncturists, naturopaths, midwives, behavioral health providers and similar can grow as holistic and integrative alternatives gain the reimbursement the premium-payers deserve and want.

That’s why we’ve turned to crowd funding, so you can make a difference. Please donate by clicking on: https://fundly.com/support-natural-therapies/

Ralph Fucetola JD
Retired Attorney at Law
President – Institute for Health Research
www.InHeRe.org

Important Notes:

[1] One knowledgeable observer notes: “CPT codes have influence on government policy by being named a mandatory standard.  CPT codes are also developed by the Centers for Medicare and Medicaid Services
(known as HCPCS I.  HCPCS II) .  By contract with the AMA, HHS agreed to ‘retire’ any HCPCS II codes that may duplicate CPT. This effectively creates a CPT monopoly. The AMA got this monopoly by giving Medicare and Medicaid a free license for use of its codes.  Every insurer, hospital and health provider in the country must pay licensing fees or royalties to the AMA for use of its codes.  This generates anywhere from $70 – $150 million a year in revenue for the AMA – as stated in a recent Forbes article. The AMA effectively hides its CPT revenue by lumping it in with other products and services.) “ – www.ABCcodes.com

[2] The Affordable Care Act (ACA, or Obamacare) amended the Public Health Services Act (PHS) by adding section 2706(a).

PHS Act section 2706(a), as added by the ACA, provides that 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.”

The Federal government’s CCIIO office states:

“The statutory language of PHS Act section 2706(a) is self-implementing and the Departments do not expect to issue regulations in the near future. PHS Act section 2706(a) is applicable to non-grandfathered group health plans and health insurance issuers offering group or individual health insurance coverage for plan years (in the individual market, policy years) beginning on or after January 1, 2014.

Until any further guidance is issued, group health plans and health insurance issuers offering group or individual coverage are expected to implement the requirements of PHS Act section 2706(a) using a good faith, reasonable interpretation of the law. For this purpose, to the extent an item or service is a covered benefit under the plan or coverage, and consistent with reasonable medical management techniques specified under the plan with respect to the frequency, method, treatment or setting for an item or service, a plan or issuer shall not discriminate based on a provider’s license or certification, to the extent the provider is acting within the scope of the provider’s license or certification under applicable state law. This provision does not require plans or issuers to accept all types of providers into a network. This provision also does not govern provider reimbursement rates, which may be subject to quality, performance, or market standards and considerations.

The Departments will work together with employers, plans, issuers, states, providers, and other stakeholders to help them come into compliance with the provider nondiscrimination provision and will work with families and individuals to help them understand the law and benefit from it as intended.”

https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs15.html