Becoming A New Patient: What Is Covered By My Insurance?

Mar 16, 2022
Becoming A New Patient: What Is Covered By My Insurance?
All too often health insurance companies deny coverage and leave patients in debt and hopeless. Here are some things you need to be aware of and steps you can take to be proactive. Don’t let the rising cost of medical care impede your treatment.

All too often health insurance companies deny coverage and leave patients in debt and hopeless. Here are some things you need to be aware of and steps you can take to be proactive. Don’t let the rising cost of medical care impede your treatment.

  1. We (NFM) do not contract with insurance companies, therefore there is no way for us to know what will be covered by your insurance plan. We will always be considered “out-of-network” by any insurance company.
  2. Naturopathic physician orders are not covered by federal insurance plans such as Medicare and Medicaid. Naturopathic physicians are not licensed in all 50 states, therefore they are not federally recognized for these programs. 
  3. Health Savings Accounts (HSA) generally can be used to cover the cost of therapies, physician visits, and blood work. They may or may not request additional documentation to support the charges. 
  4. Private Insurance plans may or may not cover office visits, therapies, and blood work depending on your specific plan and out-of network policies. In order to be reimbursed for your costs, you will need to provide a superbill to your insurance company for direct reimbursement.
  5. Cash pay options for blood work and imaging are available. If your insurance company will not cover laboratory services or radiology orders let us know! We have professional partnerships will laboratories and radiology companies to offer extremely discounted cash pay options. If you submit your bloodwork or radiology service through insurance and they do not cover the costs, you will be left with a bill that is typically 3-10Xs higher than our cash pay options. We do not want this to happen to you! 

What Steps Can You Take To Be Proactive? The More You Know… The Better!

  1. Contact your insurance company prior to your physician appointment to clarify coverage of Naturopathic medical services. Ask about the submission of superbills and reimbursement policies. Ask about laboratory services and what laboratory companies they are contracted with for bloodwork, i.e. LabCorp, Sonora Quest. Ask about what pharmacies are covered and if they cover prescriptions sent to compounding pharmacies. Ask about radiology orders and what companies they are contracted with, i.e. SimonMed. 
  2. Contact your HSA company prior to your physician appointment to clarify coverage of Naturopathic medical services. Ask if they will require a superbill to support the charges.
  3. Try to budget the costs of treatment prior to your first patient appointment. The minimal cost of your first patient appointment will be $700. If bloodwork is ordered and you would like to have your blood drawn and processed at the center, the additional cost will be $67. Your treatment plan will offer specialized immune, mitochondria, and detoxification support via supplementation. A general rough budget for supplementation should be around $200-350. In order to be fully prepared, budget roughly $900-1100. 

What Is A Superbill And Why Do I Need One? What Does All of This Mean?

  1. superbill is a detailed receipt of services needed for direct insurance reimbursement. The superbill has all of the information needed for an insurance company to accept your claim. The details needed are ICD codes, CPT codes, EIN, NPI, costs associated, and facility information. What does all this mean? In order for an insurance company to process your claim, they need to ensure that you received medical services from a licensed physician and/or legally recognized medical facility. 
  2. ICD Code: ICD codes are nationally uniform diagnostic codes that can ONLY be provided by a licensed physician. This is your diagnosis and the rationale of why you need specific bloodwork, radiology, medications, therapies and so on. For example, the ICD code R53.83 is used for Chronic Fatigue. Therefore if your physician uses code R53.83, then you have been diagnosed with Chronic Fatigue. 
  3. CPT Code: CPT codes are nationally uniform service and procedure codes that can ONLY be provided by a licensed physician or legally recognized medical facility. CPT codes indicate what services or procedures were performed on the day of your visit. CPT codes have a cost associated with them. The cost associated with the CPT code is what is used for reimbursement. For example, CPT code 99214 is for the office visit of an established patient, better known as a follow up appointment 30-60 minutes. The CPT code 99214 will have an associated cost of $250. Therefore your superbill will read, 99214 30-60 min follow up appointment $250. 
  4. EIN Number: The EIN number is the federal tax identification number for the facility. Insurance companies need this number to ensure the medical facility is a fully legal operating entity.
  5. NPI Number: The NPI, or National Provider Identification Number, is specific to your physician. Every licensed physician has a NPI. If a physician does not have a NPI, they are operating illegally and cannot provide medical services, order medications, radiology, bloodwork or provide diagnoses. The NPI of your physician has to be provided for insurance reimbursement. 
  6. Facility Information: The facility information is the legal name, address, phone number, fax number, email, and company representative. This information is need to validate the legal operations of the facility, licensure of the physician, and provide contact information if they insurance company needed to contact the facility for further information. 

If you need help with covering the cost of your treatment, please look into the LymeLight Foundation or Focus on Lyme for treatment scholarships.

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