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HMO Agrees to Make Refunds to Members

February 12, 2003

SEATTLE (AP) _ One of the nation’s largest health maintenance organizations has agreed to pay millions of dollars to settle reimbursement claims from its members in Washington state for alternative health care, such as acupuncture and the use of midwives.

The class-action settlement announced Tuesday could affect 100,000 members of Group Health Cooperative and cost the HMO as much as $10 million, lawyers estimated.

``It’s a victory for consumers who want choices,″ said Jane Guiltinan, dean of clinical affairs at Bastyr University, a natural medicine and health sciences school in Kenmore.

Three other health insurers in Washington have paid $36.2 million over the past two years to resolve similar claims and legal fees for refunds of out-of-pocket payments for alternative care.

Washington is one of several states that require insurers to cover treatment by state regulated and licensed acupuncturists, chiropractors, osteopaths, midwives, certified dietitians, nutritionists and other practitioners.

The state Supreme Court in 2000 rejected a challenge to the law by insurers who argued that expanding the list of approved providers would drive up premiums.

Group Health members went to court in 2001, challenging a requirement that they exhaust traditional treatments before being reimbursed for alternatives. The also challenged the HMO’s strict requirements for referrals by traditional physicians.

Under the settlement, members are permitted a varying number of visits to different types of alternative practitioners without referrals.

Group Health spokeswoman Keely Barrett said co-op officials believe they complied with the law but agreed to the settlement to avoid further legal costs.

Group Health has about 600,000 members in the northwestern United Sates, most of them in Washington.

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