INSURANCE FAQ

We are not contracted with any insurance companies or government run programs such as Medicare, Medical, or California Victim Compensation Board (CalVCB), so we do not provide any insurance billing.

We will, however, provide you with a superbill with necessary insurance coding for all your medical consults. The superbill is a statement with ICD-10 and CPT codes for each patient visit that communicates the necessary diagnostic and procedure information your insurance company needs to know.

Note: A superbill does not guarantee that an insurance provider will pay for the services provided. Each insurance plan is different, and it is your responsibility to contact your insurance provider and find out exactly what will be covered. These FAQ’s are designed to inform you and help you through this process.

In the state of California, naturopathic doctors are licensed to practice medicine. Therefore, unless your insurance policy specifically excludes naturopaths, by law they must cover the services. Because naturopathic doctors are usually not included on the list of covered providers, the reimbursement you will receive will usually be an “out of network” reimbursement.

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.

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.

There are a few things you can do:

1) Look at your policy.

If the “Definition of Doctor/Physician” in your policy does not specifically either exclude naturopathic physicians, or limit the definition to specific providers other than naturopaths, then you should, by law, be covered for your naturopathic services.

2. Call your insurance company.

The following are a few suggestions of what to say/ask while on the phone:

• Does my policy cover services performed by a licensed naturopathic physician? (they will typically say no, because many agents are unaware of what naturopathic medicine is)
• Does the “definition of doctor/physician” in my policy specifically exclude naturopathic physicians? (ask them to fax you a copy of the definition)
• Does the definition limit services to specific health care providers? Which ones?

Naturopathic doctors are primary care doctors licensed to practice medicine in many states.

If your policy covers naturopathic medical services, simply file your claim as you would any other medical claims by submitting your Body Blu superbill.

If your policy does not cover naturopathic medical services, you can try to modify your policy. Most insurance companies will write a plan to cover naturopathic medicine, but you must request the coverage, depending on if your plan is an individual plan or a group plan.

Individual Plan

Ask your agent to add coverage for naturopathic services. There may be a small charge for this service ranging from nothing to a few cents a month.

Group Plan

Most insurance companies do not charge anything extra to cover naturopathic services on a group plan. Tell this to your employer, union, or human resources director, and ask that naturopathic medicine be added to your plan. If necessary, organize and educate your coworkers on the value and benefit if naturopathic medicine.

For PPO plans: 

If an insurance company refuses to reimburse a patient for any services at out-of-network rates, you can appeal this decision with your 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 by clicking here.

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 naturopathic medical 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.

Often, a letter of medical necessity is required for patients to access their FSA/HSA funds. If you need such a letter, please let us know.

Note: Not all FSA/HSA plan administrators will recognize naturopathic services. Please check with your plan administrator first.

HSAs are similar to FSAs, although have the advantage of rolling over to the next year. Patients can use their HSA to pay for naturopathic medical 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.

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!

You can ask your Human Resource Departments about ND inclusion in new or existing Wellness Programs. We can give you a sample letter to customize and forward to your HR representative.