It’s the time of the season again, open enrollment for health insurance. Welcome to the blog where we delve into the intricate world of insurance coverage and its impact on your healthcare journey–at least a little bit. Over the years, I’ve witnessed firsthand the hurdles our patients face with insurance-related challenges. In this blog, I’d like to briefly touch on the issues I see come up most often.
1.) Carrier is in Network, Plan Out of Network
Often times, patients are not aware of that while a provider is in network with a carrier (“Yes, Dr. So-and-So is in network with Moda,”) they may not be in network with your plan. Plans for some carriers are limited by geographic region. For instance, while our clinic’s providers are in network for Moda, they are not in network with the Beacon plan.
Our providers are contracted with Moda, Providence, Regence Blue Cross/Blue Shield, Aetna, Cigna, and CareOregon.
2.) Carrier is in Network, No Naturopathic Coverage
Not all plans allow patients to see naturopathic physicians under their plan. This isn’t fair, and if you have not been able to work with a provider because they are a naturopathic physician, I encourage you to call your insurance company and let them know you would like this to be added to your plan.
3.) Provider Type not covered
Some of our providers are contracted as primary care providers with Providence insurance. Providence plans purchased through healthcare.gov often require that patients establish with a primary care provider within their own Providence clinics. These patients can often still see other naturopathic physicians who are not primary care providers as specialists on their plans.
4.) No Active Coverage
Understanding the active period of your insurance coverage is crucial. Dollar limits on naturopathic care should be tracked to avoid unexpected out-of-pocket expenses.
We highly suggest that you keep documentation of the information that they give you and the name of the representative you spoke with. This ensures that if something goes wrong you can hold the company accountable.
Stay proactive, advocate for fair health insurance coverage, and keep exploring the paths that support your well-being. Your commitment to understanding these nuances ensures a smoother journey toward holistic health.