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The recently lawsuit filed by Michael Grossman and his life partner Michael Ludin against the Directors Guild of America (DGA) is taking on one of Hollywood's oldest organizations. The pair are claiming discrimination and suing the 80-year-old DGA after their health plan refused to pay for naturopathic care.
While the Affordable Care Act and other health insurance regulations provide that some alternative medicines and treatments should be covered by health insurance under certain scenarios, at this stage it is unclear whether the underlying treatment received by Ludin is something that is seen as a legit or quack-treatment.
Generally, naturopathic care encompasses quite a few different types of treatments, including semi-reputable treatments such as chiropractic or acupuncture. However, naturopathic care and treatment can also be dangerous, fraudulent, and downright foolish in its denial of actual scientific effectiveness, such as with vaccines, or other modern treatments, which some naturopaths claim are bad.
You Can't Sue Under the Affordable Care Act
One major issue being fought over in Grossman and Ludin's lawsuit is whether the Affordable Care Act creates a private right of action. A private right of action is a part of a law that allows a private individual to file a lawsuit claiming that they are aggrieved by a violation of that law.
Although the ACA provided for many new laws and regulations, and explained that health plans can discriminate when they deny coverage, one thing the ACA did not provide was an independent mechanism or law for individuals to file a lawsuit under. As the legal brief for the DGA explains, the ACA modified existing laws, and did not provide any new private right of action.
Must an Insurer Pay for Naturopathic Medicine?
Whether a health insurer must cover naturopathic medicine depends on the situation and treatment. For instance, if a primary care doctor recommends or prescribes acupuncture or chiropractic care, generally, a health insurer would then be required to cover those items depending on an individual's health plan. However, if an individual seeks the care of a homeopathic, or naturopathic, practitioner on their own, even a licensed chiropractor, a health plan may not cover it without a statement regarding medical necessity.
Meeting with a lawyer can help you understand your options and how to best protect your rights. Visit our attorney directory to find a lawyer near you who can help.