It is that beautiful time of year! Yes, the leaves changing color are awe inspiring- but this is also that magical time of year when many patients have met their deductible for the year. Finally, after all those premiums and medical bills, an insurance plan is ready to really work. (After your deductible is met, your out of pocket costs for visits, medicine, and other services, such as labs, imaging, and procedures tend to be significantly reduced.) Things that have been put off now seem more attainable.
We cannot recommend enough that you know your insurance benefits. There is nothing more frustrating than getting a giant bill you weren’t expecting. For instance, before your deductible is met, you may have to pay for the full visit, procedure, or lab fees. If you have a health issue requiring several visits, especially with specialists, the price adds up quick!
If you don’t know your benefits, we recommend you call the patient service number on your insurance card. Here are some very helpful questions to ask:
1.) What is my deductible?
If you have a family on the same plan, ask if the deductible is per person or for the entire family.
What portion of your deductible is remaining?
When does your deductible restart? It may be along with the calendar year, or it may be from the start date of your plan.
2.) Are labs/imaging/medications applied to the deductible?
If your plan has any of these being applied to the deductible, your up front cost will be more.
If they are not, then even before you reach your deductible you will only pay your co-pay or co-insurance fees. Most insurances cover preventative screening labs for your annual physical full (no deductible or co-pay).
3.) Are Naturopathic Physicians a covered provider type?
Even if a provider is in network, if you don’t have specific coverage for naturopathic physicians, you will have to pay out of pocket costs for appointments. We do offer a time of service discount to help keep services affordable.
It is also important to ask if a naturopathic physician can be a primary care provider on your plan. While we are licensed as primary care providers in Oregon, not all of the insurance plans have caught up with this in their coverage. You may be required to have a primary care provider in order to receive certain services, like your annual physical exam, or your plan may require a referral from your primary care provider to see providers like naturopathic physician, physical therapist or specialist.
4.) Do I have benefits for the following:
- Chiropractic Visits
- Acupuncture
- Massage
We love to work with our colleagues in getting you to your optimal health and happiness. They serve as excellent adjuncts in your care. If you have coverage for chiropractic support, acupuncture or massage, these visits are often quite affordable and in many cases helpful.
5.) Do I have an out of pocket max?
This generally means this is the most you will have to pay for medical services, not including your premium (monthly payment). If you reach your out of pocket max, then your cost for services gets cut even further!
This can all be kind of confusing, because there are hundreds of plans out there from many carriers that are all slightly different. That is why it is important for you to call and find out what your plan is and how it can best serve you and your health! If you are searching for insurance for next year, try working with a health insurance broker to help you better choose the best plan for you and your family.