For Patients

Using Insurance For Your Naturopathic Doctor Care

According to the Affordable Care Act, the primary care services provided by your naturopathic doctor should be covered by PPO insurance plans. However, even though the services you receive from your naturopathic doctor are for the same primary care procedures that an insurance company would cover if offered by an allopathic (conventional) doctor, many insurance companies do not yet reimburse patients for services provided by a naturopathic doctor. We believe that insurance companies need to comply with the federal Affordable Care Act by covering or reimbursing patients for visits to a naturopathic doctor. 

You can help make insurance coverage for NDs a reality! In the meantime, we offer the following information to help you make the best choices for both your naturopathic care and in case of a medical emergency:


How can I make the best use of my insurance coverage?
What is a superbill?
How do I find out what my insurance company will reimburse for an out-of-network provider?
How can I take advantage of a Health Savings Account?
How can I take advantage of a Flexible Spending Account?
What do I do if my insurance doesn't cover my naturopathic doctor?


How can I make the best use of my insurance coverage?

Naturopathic healthcare, with its focus on holistic prevention, will likely reduce your need for expensive prescription drugs and your risk of being hospitalized (research shows this, too). However, medical bills are the #1 cause of personal bankruptcy in the U.S. – it makes sense to protect yourself in the event of the unexpected by participating in a health insurance plan.

Some people opt for high-deductible health plans. In this choice, you may pay a lower monthly premium, freeing up your monthly healthcare budget for out-of-pocket expenses such as naturopathic doctor visits and supplements (a Health Savings Account can help even more – see below). You can submit superbills and lab bills you receive from your naturopathic doctor to your insurance company, which may start counting those expenses toward your deductible cap. If something catastrophic does happen and you haven’t reached your cap, you will have to pay out of pocket until your insurance kicks in. You should make sure you are comfortable with the out-of-pocket cost should something catastrophic happen.
Note: your annual preventive visit should be covered by your insurance, even if you don’t reach your deductible.
(Source: 6 Ways to Optimize a New Health Savings Account, The Fiscal Times)


What is a Superbill?
A superbill is an appropriately coded bill produced by your doctor based on the type of visit you received and the reason for your visit. A superbill is coded for insurance purposes and is different from an invoice or receipt. If you have a PPO plan, you can submit a superbill to your insurance company for services received from your naturopathic doctor to receive reimbursement for a portion of the fees you paid your doctor’s office. Ask your ND if they can provide you with a superbill at the end of each visit. Call your insurance company to find out exactly how they would like a superbill submitted – generally, sending a copy of your insurance card along with the printed superbill to the mailing address on the back of your insurance card is all you need to do. If your insurance company recognizes your naturopathic doctor’s out-of-network services, they will reimburse you the costs (or a portion of the costs) of your visit.

More detailed instructions for submitting a superbill can be found here. If you have already been denied reimbursement after submitting a superbill, you can find information about filing a complaint here

How do I find out what my insurance company will reimburse for an out-of-network provider?

  • Call the customer service phone number listed on your insurance card.
  • Ask, “I want to work with an out-of-network naturopathic doctor, how much will you reimburse me?”
    • Many insurance companies’ customer service representatives have never heard of naturopathic doctors, or do not know what we are licensed to do in this state. If they ask what a naturopathic doctor is, you can tell them, “Naturopathic doctors are licensed primary care providers in the state of California.”
  • Ask, “What is the best way to submit my claim with a superbill?”
  • Be sure that your benefits are clear to you.
  • Give it a try anyway! It never hurts to submit your superbills to your insurance company. We are finding that many companies will reimburse a portion of your out of pocket costs.

How can I take advantage of a Health Savings Account?
Most employer-offered high-deductible health plans are paired with a tax-free Health Savings Account (HSA). You can set one up yourself too – if you are shopping for a new plan make sure it is “HSA compatible.” In 2014, you can contribute up to $3300 pre-tax by having funds automatically deposited into your HSA from your paycheck. Depending on your tax bracket, that can be a 35% savings right away. Employers often match contributions, leading to further savings. HSA funds are also tax-free when you withdraw the funds, and the money is yours to keep if you don’t spend it all that year. Money in your HSA can be used to pay for qualifying medical expenses, including medical appointments with your naturopathic doctor, lab tests, prescribed supplements, over-the-counter products, and other medically necessary prescribed services (for instance, massages for back pain). Some HSAs provide a debit-like card, others require you to submit receipts for reimbursement. You may ask your doctor for a Letter of Medical Necessity detailing your dietary supplement prescriptions for reimbursement.
(Source: Affordable Care Act: Questions and Answers on Over-the-Counter Medicines and Drugs, The IRS).


How can I take advantage of a Flexible Spending Account?
Flexible Spending Accounts (FSAs) are much like HSAs, except you are at risk of losing your contributions by the end of the year. Even so, they can be a good idea if you know how to budget your healthcare expenses. For example, you know the cost of visits to your doctor, plus you estimate you will need a massage every other month to manage chronic neck pain and you know you will be taking a multivitamin and two other supplements to prevent future disease and manage your cholesterol. With that knowledge, you can have pre-tax contributions added to your FSA from your paycheck. If you reach the end of the year and haven’t spent your set-aside funds, your doctor can help you determine if there are pro-active steps you could invest in: for example, additional testing or new glasses.


What do I do if my insurance doesn't cover my naturopathic doctor?
Patients are often the most effective advocates for improving insurance coverage of naturopathic doctor services. There are a number of steps you can take:

  1. Sign up on the CNDA’s Advocacy page to stay up to date on this issue and be alerted when state insurance legislation will be voted on!
     
  2. Print this letter and attach these informational documents to mail to your insurance company's customer service department.
     
  3. Is your insurance plan offered through your employer? Print this letter and attach these informational documents to give to your human resources representative. They can forward it directly to your insurer and use it when negotiating next year’s benefits package.
    • If you have no HR representative, you can ask your company's management to determine who makes decisions regarding employee benefits. 
       
  4. Depending on the type of health care coverage you have, there are different ways to lodge a complaint against an insurance company. First you need to find out if your health benefit is regulated by the Employee Retirement Income Security Act (ERISA). 
    • ERISA typically covers insurance plans offered by a private employer. Insurance plans offered by non-private employers (like those listed below) are not covered under ERISA regulations.
      • Non-ERISA plans are provided by: state or federal government agencies, Medicare, Medicaid, public schools, Workers’ Compensation, the military, churches, and individual health plans for people who are self-employed or are not employed by a private employer.
         
    • If you have a health plan governed by ERISA and you have been notified that a claim for coverage of ND services has been denied, you can submit a complaint to ERISA. Step-by-step instructions for beneficiaries to appeal denials are available here.
       
    • A general overview of ERISA is accessible here.
       
  5. If your plan is not covered by ERISA, contact the California Department of Insurance (DOI) to file a complaint. Click here for instructions on filing a complaint and a link to the CA Department of Insurance's complaint form.

 

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