Key Takeaway
Explore the Forrest Chen v. GEICO case and its impact on acupuncture insurance reimbursements in NY. Key insights for providers and patients.
This article is part of our ongoing fee schedule coverage, with 123 published articles analyzing fee schedule issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
I’ve been reviewing my old blog content and wanted to revisit my first post. These legal precedents still matter as personal injury practice keeps changing.
Forrest Chen Acupuncture Services, P.C. v. GEICO Ins. Co. (2008 N.Y. Slip Op. 07211, 2d Dept.) sheds light on how insurers handle acupuncture payments. This New York case has major effects on providers, insurers, and patients.
Background: Understanding Insurance Requirements
The dispute between Forrest Chen Acupuncture Services, P.C. and GEICO Insurance Company originated in 
2001 as alternative medicine gained acceptance in mainstream healthcare. The central question addressed how insurance companies should calculate and process acupuncture treatment reimbursements.
The legal basis is New York Insurance Law § 5108. This law governs medical payments, including acupuncture. It works alongside regulation 11 NYCRR 68.5(b). That rule limits payments to “charges permissible for similar procedures under schedules already adopted.”
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GEICO’s Legal Position
GEICO presented compelling evidence showing no established fee schedule existed for acupuncture treatment reimbursement in 2001. This absence became central to their defense.
The New York Insurance Department General Counsel backed GEICO’s stance. Their opinion (Ops Gen Counsel N.Y. Ins Dept No. 04-10-03, October 2004) confirmed that acupuncture payments must follow existing schedule limits. This official support made GEICO’s position much stronger.
The Plaintiff’s Case Falls Short
Forrest Chen Acupuncture Services, P.C. failed to mount an effective challenge against GEICO’s evidence. The plaintiff needed but did not provide:
- Relevant fee schedule portions with conversion factors
- CPT Codes and relative values
- Department of Insurance confirmation letter
- Claims examiner affidavit verifying compliance
Without this documentation, the plaintiff could not establish factual disputes against GEICO’s argument.
Court Ruling and Impact
The court granted GEICO’s summary judgment motion and dismissed the complaint. This ruling made clear that providers must follow set fee schedules for medical payments. This applies to alternative treatments like acupuncture too.
This ruling affects many groups. Acupuncturists and other providers in Long Island, NYC, and beyond must keep proper records and follow the rules. Insurance companies got support for how they handle alternative treatment payments. Patients should check their insurance policies to see what alternative treatments are covered.
Alternative Medicine and Legal Requirements
The Forrest Chen case shows how alternative medicine is becoming part of mainstream healthcare. As more people use treatments like acupuncture for chronic pain and stress, insurance coverage matters more than ever.
Healthcare providers face strict rules to get paid properly. Patients deal with complex insurance policies that control alternative treatment coverage. Both groups gain from knowing the laws and rules that apply.
Selecting Legal Representation
The Forrest Chen case shows why good legal help matters in healthcare and insurance disputes. Whether you provide healthcare services or seek insurance coverage for treatments, experienced attorneys can:
- Explain relevant laws and regulations
- Review documentation requirements
- Protect your legal rights
- Challenge unfair claim denials
- Navigate insurance disputes
The Law Office of Jason Tenenbaum, P.C. serves Long Island and NYC with deep knowledge of insurance law, healthcare regulations and alternative medicine issues. Their experienced team handles cases like Forrest Chen while advocating for fair treatment in insurance and healthcare matters.
Final Thoughts
The Forrest Chen case is older, but it still shows the strict rules around healthcare payments for alternative medicine. To succeed, you need to understand the regulations, keep thorough records, and often hire a skilled attorney. As more people seek alternative treatments, these lessons matter more than ever.
Check out the original article on fee schedule defense and DOI deference.
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Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a fee schedule matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
