Over the last few years I have noticed that there can be a few major issues that come up with insurance coverage that have affected our patients:
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, CareOregon, HealthShare, United, and CHP Kaiser Plans.
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
I know this may sound obvious, but we have had it happen time and time again. Make sure you know when your insurance coverage starts and stops. If you have a dollar limit on naturopathic coverage (such as with a CHP Kaiser plan), make sure you know when this restarts and how much you have remaining to avoid excess out of pocket expenses.
We try to give patient’s accurate information, but because of the wide variance in plans and coverage and the fact that we have been given incorrect information from insurance companies in the past, we will not do individual verification. Attached is our insurance verification form that may help you figure out if your insurance covers our providers. I 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.