Ultimately, it is the patient’s responsibility to know what their benefits are. Please remember, “Covered” does not always mean” Pay” and copay’s may be different for an exam than a spinal manipulation. Your insurance benefits are not a guarantee of payment; they are only a quote from your insurance company. We will make every effort to follow benefit guidelines. Although, you are still responsible for making sure that all required authorizations, pre-certifications and physician’s prescriptions are in order prior to and during treatment.
Since the insurance world likes to change things for all of us (both patients & health care workers) without notice, it’s inevitable that something may fall through the cracks when it comes to insurance coverage. Here are a few examples of what may happen :
- Prior Authorization is/was required.
- Referral from your Primary Care Provider is/was required.
- Underpayments leading to an Outstanding Balance can occur if your plan/coverage changed.
We want your insurance to work with you, not against you!
Understand Your Insurance Responsibility
How to Check Your Benefits for Naturopathic Medicine & Dietician/Nutrition Coverage
If you’d like to find out if your insurance plan offers benefits & coverage for Naturopathic &/or Dietician/Nutrition medical services, here are a few things you can do:
1. Review your insurance plan portal, handbook & policies.
- Sometimes your insurance plan documents will specifically say if Naturopathy/Naturopathic Medicine &/or Dietitian/Nutrition is covered.
- If you have an HMO plan you may be limited to seeing providers who work for that company (for example Kaiser). In most cases these plans will not cover naturopathic medicine.
2. Call your insurance company.
To check your insurance benefits, call the customer service number on the back of your insurance card. Ask for benefits/coverage/eligibility. Tell the phone representative you’re calling to verify your insurance benefits & coverage.
Here is a general list of the questions you may want to ask your insurance:
- Does my policy cover services that are performed by a licensed Physician &/or Dietitian? (If your insurance is unsure, you can ask if your policy specifically excludes Naturopaths as covered providers in its definition of physician.)
- Is there a specific deductible I need to meet in regards to these services?
- How much of my deductible do I still have to meet this year?
- Is <Provider's Name> in-network with my specific plan?
- What is my copay or coinsurance in regards to these services?
- Is a referral required from my Primary Care Physician in order to see <Provider's Name>?
- Is there any other pre-authorization required?
- Do I have a maximum number of visits, or a maximum dollar amount for these services each year?
- If your health insurance plan does not cover Naturopathic &/or Dietician/Nutrition services, you can still make an appointment! Please review our out-of-pocket/cash rate below!
- Specialist vs. PCP :: We are not credentialed & considered as primary care providers (PCPs with any insurance company. We also do not bill as PCPs. We’re credentialed as, considered as & bill as Specialists - Naturopathic Doctors. As mentioned on our website & on our New Patient Application as a statement you agreed to to confirm your application: "We offer primary care services, but according to commercial insurance, we are not defined as a primary care physician (PCP): we are defined as specialists (naturopathic physicians).”