Red Tape. That's what it is all about. How do I get my insurance to cover my naturopathic care? Meanwhile the insurance company is asking 'How do we avoid paying for naturopathic care?' The big question is "How do I even find out if my naturopathic care should be covered under my plan?"
In unlicensed states--where naturopathic physicians are not recognized by any health board--forget about it. You will pay out of pocket for anyone you go see as a health coach. You insurance will not cover anyone who is not licensed as a health care practitioner. It would be illegal for them to do so. If the naturopathic doctor is also a chiropractor or accupuncturist, they can bill for these services, but time spent for naturopathic services (reading of test results, creating a treatment plan with dietary and lifestyle management changes) is not covered by your insurance. The doctor cannot bill the insurance for a body work (chiropractic) code if the chart notes do not reflect that treatment. Insurance companies can ask for chart notes and even demand money back years after they 'accidentally' paid a doctor.
In licensed states: naturopathic physicians may be considered 'alternative' practitioners or 'primary care' physicians depending on the laws in that state. Some health plans have specific coverage for alternative care vs. primary care. It is important to ask your insurance plan where naturopathic visits fall. Some insurance companies demand that you specify one doctor as your primary care physician. If you have specified a certain doctor and then go to another doctor who is a naturopath for an annual physical, your insurance can deny payment for that visit. You can still see a naturopathic doctor for other health concerns and get it paid by your insurance, just not for the once-a-year health physical. To get annual health exams at a naturopathic office paid for, you may have to specify your naturopathic doctor as your primary care doctor. I am pointing this out because many insurance plans waive the deductible for one health visit per year. If you are trying to get your one visit paid for by insurance, you may have to see your primary care doctor for this visit.
Deductible? Some people don't understand what a deductible is. Insurance companies make deals with you based on your expected usage of their coverage. They are betting that you will go to the doctor and you are betting that you will stay healthy. A deductible is the amount you have to pay the doctor per year before your insurance kicks in. For instance, your insurance might offer you a plan where you pay $200 per month and you have no deductible. You can go see a doctor anytime and your insurance will pay. OR, if you want to pay only $170 per month, they will put a $500 deductible on your plan but you can see a doctor for one health check up and the deductible is waived. Sounds pretty good, until you want to see a doctor for your ear infection or strep throat or hot flashes and you have to pay $500 worth of visits before your insurance will pay anything. (so you saved $360 per year by paying $500). The doctor cannot code this visit as a health check up if you have a new diagnosis code for a new health complaint. Remember...most deductibles renew in January. So if you have already paid your deductible by the time Fall comes around, don't wait until next year to see the doctor! Your insurance will finally pay for your health visits! If you're lucky, your insurance will cover 3 or 4 visits before the deductible kicks in. But even in these cases some codes are 'subject to the deductible'. Since naturopathic physicians spend more time explaining things to you and developing a treatment plan specific for you and your multiple diagnoses (thus they spend more than just the 5 minutes typical M.D.s spend with you), they will bill for an additional time code. On many plans, the patient has to pay for the amount billed for these codes until the deductible is paid off. If your naturopathic physician has had time to verify your insurance before your visit, they should know this information.
Whew! still with me? Read on....
Max per year: pay attention to this especially if on your health plan naturopathic physicians are classified as 'alternative care'. You may have a max per year for alternative coverage. Even if it is high, say $1200, remember that that amount will be shared by your chiropractors, accupuncturists and massage therapists. If you see all these types of practitioners, your coverage could be used up before the end of the year, at which time you would be responsible for paying the naturopathic visits--or massage visits--or whatever comes last chronologically after the coverage has run out.
'In Network' or 'Out of Network': Your insurance plan probably has different coverage for naturopathic physicians who are in network or out of network. If a naturopathic physician is 'in network' on your plan, they have agreed to accept the amount your insurance will pay and you will only pay a co-pay (that is after the deductible, see above). This also gets you discounts on visits you have to pay if you are still paying on your deductible. For instance, if a physician normally charges $200 for a visit, but your insurance has said the price for that visit should be $160, you get the discount. Of course, if you don't have a deductible to pay, you only pay your co-pay and it doesn't matter to you what price the doc and insurance have agreed upon. If your insurance has a 20% copay for in-network and a 40% copay for out-of-network, that means that if your doctor is out of network, you will pay 40% of the $200, whereas if they were in network, you would pay only 20% of $160 (the discounted price). With out of network docs, they can set the price. If the out-of-network doctor you see is in-network with other insurance plans (just not yours), the price will be reasonable. However if it is a doc that does not bill any insurance whatsoever, the price can be high. It is good to ask what the charge will likely be in these cases. Some out-of-network doctors will bill the charges for you, and others will ask you to send in receipts for reimbursement yourself. Some insurance companies have no out-of-network coverage at all. Then you have to pay the whole price. To find out if the doctor you want to see is in network with your plan, go to your insurance website. Doctors names should be listed there. Don't stop there, though. You might have good out-of-network coverage. Find out by calling the number on the back of your insurance card.
What about the Federal Health Care Reform? As of now, naturopathic physicians are not part of the Federal Health Care Reform Plan. That means that naturopathic physicians will get paid the same amount they now get paid by Medicare--ie: nothing! I am not disappointed because traditionally Medicare does not pay well. Many M.D.s are going out of business because Medicare did not pay them well enough for their services. Yes, going out of business. Retiring. It's not just about making less money. It's about making money at all. People ask why I don't accept certain insurance plans. It is because they do not pay well enough. Friends who are also naturopathic doctors post pictures (on Facebook) of checks they get from certain insurance companies--checks for $0.13 (that's thirteen cents!) and even one time a check for $0! Yes, a check was actually sent for zero dollars and zero cents. What companies pay so poorly? ASH (American Specialties Health) and Kaiser. Avoid them like the plague.
The best way to know if your insurance pays naturopathic care, what your deductible is, and if a max per year applies, call the number on the back of your insurance card and ask all these questions. You can also ask the HR representative at your work. Our office will call and check for you before your visit if you give us the information at least 24 hours in advance of your first visit (48 hours in advance would be better).
I hope this has answered your questions about how to find out if your insurance will cover your naturopathic visits. It is not uncommon to be confused about all of this. Call your insurance to find out what your levels of coverage is, then refer back to this article for a better explanation of what the terms mean. For us to do it for you when you have an initial visit scheduled, call us at 360-573-2273.
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