Patients are often the best advocates for increasing insurance coverage of naturopathic medical services, but doctors play a crucial role in keeping patients informed and giving them the resources necessary to become effective advocates.
This page gives doctors information on the types of insurance plans available to patients and how to best use each plan to cover your services, resources for providing your patients with superbills (including templates and CPT coding resources), and step-by-step instructions for applying to be an in-network provider with California health insurance plans.
Help your patients make the most of their insurance coverage
The likelihood of a patient being able to use their health insurance pl an for naturopathic services depends on the type of insurance plan your patient has.
- Preferred Provider Organization (PPO): Patients who have PPO insurance plans can submit a superbill from their ND for primary care services received. ND services should be reimbursed at the “out-of-network” provider rate. See the links below for a superbill template, as well as instructions for patients on how to submit a superbill. If an insurance company refuses to reimburse a patient for your services at out-of-network rates, your patient can appeal this decision with their insurance company and, if denied in the appeal, file a complaint with the California Department of Insurance. Step-by-step instructions on filing a complaint are available on the Filing a Complaint page.
- Health Maintenance Organization (HMO): Patients who have HMO plans generally are only covered by providers within their network. Services for out-of-network providers are not reimbursed. However, some HMO plans will cover labs ordered by out-of-network providers. It is important to encourage your patients to check with their insurance company about coverage for lab work. Unless you are credentialed with an insurance company as an in-network provider (see below), your patient will most likely be ineligible for reimbursement for your services.
- Flexible Spending Account (FSA): Many traditional insurance plans offered through employers provide employees the option to put aside pre-tax earnings toward their health care costs. This money goes into their FSA, which is sometimes matched by their employers. FSAs can be used to pay for services that are not covered by their insurance plan such as ND care, lab work, and supplements. FSAs do not roll over into the next year, so it is important for individuals with an FSA to plan ahead and budget for the year. NDs can help their patients set up this budget by helping them project their preventative care costs for each year. Flexible spending accounts are accessed either through a debit card that can be run by a credit card reader, or will be reimbursed to the patient when the patient submits a receipt to their FSA administrator. Often, a letter of medical necessity is required for patients to access their FSA/HSA funds. Note: Not all FSA/HSA plan administrators will recognize naturopathic services. Please check with your plan administrator first.
- Health Savings Account (HSA): HSAs are similar to FSAs, although have the advantage of rolling over to the next year. Patients can use their HSA to pay for ND care, lab work, and supplements. Employers may match contributions to HSAs, too. Similar to an FSA, HSA funds can be accessed via a debit card, or the patient can pay for their expenses out of pocket and submit their receipt for reimbursement. Note: Not all FSA/HSA plan administrators will recognize naturopathic services. Please check with your plan administrator first.
- Employer-Based Wellness Programs: More and more companies are creating wellness programs for their employees as an additional benefit. Parker-Hannifin, an engineering company with several locations in Southern and Northern California, networks directly with NDs and reimburses 70% of billed expenses. Providence Health and Services, a large employer in Southern California, also provides ND benefits for their employees. Providence health plans cover NDs as either in-network or out-of-network providers. Other large companies such as Target, Cisco, and Safeway are in the process of creating Employer-Based Wellness Programs. The more that employers hear from their employees about including naturopathic doctors in health plans, the better!
Encourage your patients to ask their Human Resource Departments about ND inclusion in new or existing Wellness Programs. You can share this letter with your patients for them to customize and forward to their HR representative.
For a patient to request reimbursement for your services from their health insurance plan, you will need to provide your patient with an appropriately coded superbill after each visit. The CNDA offers members superbill templates, resources for learning about CPT codes and coding, and informational handouts to provide patients about submitting superbills and filing complaints should reimbursement be denied.
- Downloadable Superbill Templates
- Coding Guidelines:
- Patient "How to" Handouts:
- How to submit a superbill
- How to submit a complaint to the Department of Insurance when reimbursement has been denied. Encourage your patients to submit claims to the CA Department of Insurance if their PPO denies reimbursement for primary care ND services. These claims will demonstrate the need for state regulations on insurance practices and encourage the state to pass laws barring insurance companies from discriminating against NDs.
- Patients can also be directed to www.calnd.org/patients for more guidance on submitting a superbill or filing a complaint.
Interested in improving insurance coverage for your patients?
The CNDA is working to gather information on whether or not California insurance companies are reimbursing or covering patients for visits to naturopathic doctors. To this end, we are currently working with naturopathic clinics to compile documentation from patients on insurer responses to superbill submittals. The CNDA is gathering this evidence to share with the California Department of Managed Health Care and the Department of Insurance, the state agencies responsible for regulating insurance companies in our state. If you are a naturopathic clinic and would like to participate in this project, please see our page on Collecting Patient Denials for step-by-step instructions.
Applying to Medi-Cal?Step-by-step instructions for submitting an application to become an Ordering/Referring/Prescribing Provider can be found here.
What to Expect as an Ordering/ Referring/ Prescribing Provider with Medi-Cal
How does Medi-Cal work for NDs?
The whole process of getting credentialed takes 2-3 months, not because of the paperwork involved, but because of the time it takes for Medi-Cal to confirm credentialing with you. It is important to keep in mind, NDs do not get reimbursed for visits. But, when an ND orders labs, imaging, or prescriptions for patients with Medi-Cal, those things will now be covered whereas before they were not.
There are no restrictions on what you order other than what Medi-Cal considers a medical necessity like any other insurance provider. If the codes match the order in their system it gets covered and if not, they will write you a letter. Some prescriptions will require pre-authorizations but they will tell you that before they give it to your patient after they receive the order. You do not need to check Medicaid on the order form, the patient should give their insurance information to the lab directly.
Which laboratories accept Medi-Cal?
Several labs accept orders from NDs credentialed with Medi-Cal, including:
- LabCorp - www.labcorp.com
- Mercy Medical Center - www.dignityhealth.org/mercymedical-merced/
- Fairchild Medical Center - www.fairchildmed.org/ | 530-842-4121
- MD Imaging – www.mdimaging.net/ | 530-243-1249
What information do I need to provide if my order is questioned?
If you’re working with a lab for the first time or your order is questioned, try these steps for confirming your order:
- Send the lab your Ordering Provider Number – issued with your approval letter from Medi-Cal.
- Call Medi-Cal and give them the contact information for the lab in noncompliance. Ask Medi-Cal to follow up and clarify with the lab.
- Let the CNDA know if your orders are still being refused, Frances McAdam, Membership Coordinator at the home office, can help too.
What is the process for referring a patient?
Medi-Cal will accept referrals to specialists from NDs whereas before they had to come from someone contracted with Medi-Cal for them to pay for that specialist.
Apply for in-network status with insurers and employer-based health plans
Step by Step Instructions for How To Apply To Become An In-Network Provider
- Create an account for the CAQH universal provider database.
- Go to http://www.caqh.org/participatingorgs.php.
- Call one of the companies listed. Suggested companies include Aetna (1-888-632-3862) or United Healthcare (1-877-842-3210).
- Ask to speak with the Provider Enrollment Department.
- Ask the Provider Enrollment Department for a CAQH Universal Database Provider ID. They will request your state license, driver’s license, or possibly other identifying information.
- Once you have received your Provider ID, visit the following website: https://proview.caqh.org/Login/.
- Once you set up your User ID and password, you can login and complete your application. It will take approximately 2 hours but will save you from having to repeat the same paperwork for each individual insurance company you plan on asking to become a provider for. You will need a copy of your:
- State license,
- Malpractice insurance policies,
- DEA certificate if you have one, and
- IRS form W-9 if you have one.
- Visit the websites of the health insurance plan you would like to apply to. See the List of California PPO Health Plans for suggestions. Request an application to be sent to you.
- Send in the application and Letter of Intent for each individual health insurance plan you would like to apply to become an in-network provider for.
- Await a response, which may take up to 60 days. If you are satisfied with the offer letter, sign the contract.
If you receive a contract offer from an insurance company, you are not obligated to accept the offer. The CNDA is working on improving insurance coverage to expand consumer access to naturopathic medicine and improve the financial viability of practicing in California. Reimbursement rates are a crucial component of ensuring that increased insurance coverage benefits NDs. When considering a contract offer, keep in mind the financial implications of varying reimbursement rates for your practice. Regardless of whether or not you accept an offer, please forward all documents to the CNDA by fax (815) 550-2411 or email (email@example.com).