Help Get REAL Healthcare Paid For vs.
Continue Funding Disease Care
Making Health Insurers Follow the Rules
Opinion by Ralph Fucetola JD
Until it is not profitable for them to do so, insurers will keep pushing drugs and surgeries on consumers as their only healthcare options.
The Affordable Care Act became law in January of 2014. Section 2706 of this law prohibits health insurance payers from discriminating against any provider who is acting within their legal scope of practice. The trouble is, this law is vague and the government is not going to clarify what it means.
Congress intended the Affordable Care Act to require insurers to cover the services of any provider who is qualified by state law to provide care for ailments (example: for low back pain) if the ailment is paid for when provided by a physician.
Unfortunately, no court has yet required an insurer to make payments under this law.
I know of a current case that, if won, will establish this legal president.
Before I retired from practicing law to run the Institute of Health Research, I helped defend this practice against the state medical board. I got close to this group of alternative medicine providers during that time and learned that they were getting reimbursed by several insurance companies.
They offer various IV vitamin and mineral therapies overseen by a physician and delivered by nurse practitioners. They also have a naturopath on site to provide dietary counseling. In 2017, a Blue Cross Blue Shield plan sued them for filing claims for alternative medicine and for filing “fraudulent claims.”
I’ve decided to help them in any way I could because I believe these providers are being bullied and could, if they won their case, put all other insurers in the US on notice that this type of behavior is no longer going to be tolerated by the courts.
The Institute has established a crowd funding site to assure this case has the broadest impact possible for all providers and patients.
Without outside support, the provider is going to have to file bankruptcy just to respond to the enormous amount of legal paperwork being generated by the insurer’s lawyers.
Your help can make all the difference.
If we join together, we can create a powerful crowd-funded war chest built from your donations. The monies will be held to protect any provider or any patient who is being discriminated against by any insurance company. We’ll start with the case of Horizon v Jonuzi et al, so we can help pay for the young and aggressive lawyer defending the providers.
Every provider in the country who is not practicing conventional medicine would benefit if this group of providers wins their lawsuit. So would every patient seeking advanced healthcare alternatives.
Imagine if every provider and every patient who used alternative medicine contributed $5 = $5 million for each 1 million out there. AND, having a legal war chest will deter other bad actors in the insurance industry from bullying providers and denying claims to patients.
The courts have the authority to protect patients’ rights to reimbursement but this type of suit is very expensive.
Without your help, the integrative health care practice being sued by Horizon BCBS will be destroyed because the insurer can afford the top-priced, tough – and mercenary — legal talent. The doctors and practitioners being sued cannot hope to match their power but they can win with your help.
Most targeted providers give up and give in but these providers are willing to fight and their attorney and their experts believe BCBS has a very weak case. If these defendants succeed, this case will set a precedent that requires other insurers to play fair.
We are optimistic that this Blue Cross Blue Shield plan can not only be stopped but also punished for violating Section 2706 of the Affordable Care Act.
There are 18 legal mistakes that BCBS’s lawyers are hoping to cover-up. They are listed below* and we detail them on the crowd funding web page. Go there now to find out more: https://fundly.com/support-natural-therapies
These important issues will not be heard by the court without sufficient funding.
Please go to https://fundly.com/support-natural-therapies to donate today. This is a cause well-worth your support! Motions to suppress the practitioners are pending. We must act now.
Opinion by Ralph Fucetola JD
Ralph Fucetola, JD, President
Institute for Health Research
PS – please forward this plea to all your circles of influence: https://fundly.com/support-natural-therapies
 See Provider Non-Discrimination at: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs15.html
 Congress did not require insurers to contract with any willing provider. This means that insurers can deny coverage under an HMO because HMOs only cover in-network providers. However, the rule does not apply to Medicare Advantage Plans (HMOs for seniors). These plans require representation on the PPO network for any legally qualified provider – sufficient to meet the needs of policyholders.
* The errors identified so far include:
1. Primarily based on accusing Defendants of providing “fraudulent” healthcare services.
2. Defendants have never provided fraudulent services to patients
3. Defendants accused of “mis-coding” services
4.The codes used by Defendants to file claims were not used incorrectly.
5. An outside billing expert reviewed Defendant’s claims and found that their claims used the treating and supervising provider NPI numbers in the wrong slots.
6. This same expert will testify as to the difficulty of using the numbers correctly.
7. Horizon did not point to errors related to NPI number placement in its audit.
8. Instead, Horizon withheld payments to AIM shortly after submitting its audit results to Defendants.
9. Without giving AIM a chance to correct its billing errors, BCBS violated Defendants rights under New Jersey law: NJSA 17:17-29b(4).
10. AIM purchased an electronic system to better tie patients notes to patient visits after the Horizon audit pointed out this weakness.
11. This action proves that Defendants took BCBS’s audit seriously and tried to comply with Horizon’s best practices.
12. However, BCBS quit paying claims after its audit and seems to have assumed that Defendants were committing fraud instead.
13. BCBS’s presumption of Defendants’ violation of the Fraud and Abuse Act under HIPPA law has financially damaged Defendants.
14. BCBS also seems to have attempted to damage Defendants reputation with patients .
15. BCBS did not ask these patients if they were helped by Defendants’ treatments.
16. Over the past 15 years, no patients have never complained of the care they received.
17. BCBS claims that it does not cover Alternative Medicine.
18. In fact, BCBS’s statement violates Section 2706 of the Affordable Care Act.