One of the orchid's common names, lily-leaved twayblade, comes from the plant having two connected basal leaves.

In the eastern United States, it is found in the Appalachians, Ozarks, the Great Lakes region, and the Ohio and Upper Mississippi Valleys, but not the southern coastal plains.

While the plant is considered globally secure, it is rare or endangered in many northeastern states due to declining populations.

[4][7] The North American Orchid Center has stated that it is possible for insects with either long legs or mouthparts to pollinate its flowers.

[4] Threats to the orchid include flooding caused by beavers, swamp habitat being drained, and insecticides that kill the flies which pollinate the plant.