A Naturopathic Narrative About Medical Insurance
“Do you take insurance?” This is one of the most frequently asked questions we get at the clinic. The short answer to this question is “no,” but as with most things in life, there is a deeper and more complex answer and reasoning for our decision. So, here’s a longer answer:
Quite frankly, I would love to take insurance to help ease the financial burden of healthcare for my patients. This would be possible if insurance companies paid a fair wage for the time that I spend with my patients, had a streamlined billing process, and valued educational, preventative care the same way I do. As most of you know, this is not currently a reality.
A little background for you so we can begin to have this conversation:
In the insurance world, billing is done using codes called CPT codes--a complex system that reduces what we accomplish in a healthcare visit down to just a few numbers. For instance, in a follow-up visit with me, we may talk about your fatigue and thyroid concerns. I may take a few physical exam notes (such as blood pressure, alertness, heart rate, etc.). All of this would be boiled down to a code: 99213.
But a 99213 code in the conventional medical world and naturopathic medical world are not equal in terms of patient care or clinic sustainability, and here’s why:
In a conventional medicine context, a follow-up visit is about 5-10 minutes long and the clinic gets paid a set amount of money from the insurance company in exchange for billing through them. In my naturopathic context, this is a 30-minute visit where we may spend a good portion of the time troubleshooting your diet and barriers to moving your body, along with adjusting medication and supplement dosages, and then we may throw in some counseling about the stressors in your life—ALL of which I find to be essential for accessing truly sustainable well-being.
If we did bill insurance at Northwest Life Medicine Clinic, the insurance company would indeed pay me for that 99213 code. However, they often pay NDs less for that 99213 code than they pay an MD. With the way our insurance world is currently set up, I spend triple the time of the MD and still get paid significantly less. As if that’s not bad enough, the billing process has become so complex that I could either spend literally half of my time in communication with insurance companies, or I could hire someone do it for me, increasing my overhead, limiting the time I am able to dedicate to patient communication, and ultimately leading to shorter visits because I need to see more 99213’s to pay the bills. It’s a horrible cycle that most practitioners, conventional and otherwise, are simply stuck in. It’s been the demise of many a naturopathic practice, and it’s leading to more practitioner burn out as well as lower-quality care. Nobody wins in this system… except the insurance companies, of course.
What Options Do NWLM Patients Have?
We are out-of-network with all insurance, but that doesn’t mean you can’t get your visits covered by your insurance. We are happy to provide you with something called a “Superbill”—it has all the CPT insurance codes and diagnostic codes from your visit (with the visit fees already paid)—that you can provide to your insurance company. They will apply it to your out-of-network deductible and total out-of-pocket expenses. Depending on your specific plan, some folks get some reimbursement, some do not. We can’t make any guarantees about this because there are so many different insurance plans out there, but you can call your insurance company and find out what holds true for your plan.
Not taking insurance can be a limiting factor to patients receiving care at our clinic, which is why we do our best to make our services as accessible as possible. We offer discounts on services for children and folks on Medicare or Medicaid. We have flexible payment plans available, and Dr. Garrison offers an Open Doors program, which allows patients half-priced visits for a limited number of visits (space in this program is limited). We also go the extra mile in limiting the healthcare costs outside of our clinic by negotiating and contracting with local labs to get the cheapest blood labs available for those whose insurance would not cover labs and helping to find the most cost-effective imaging if needed. (Note that many labs and imaging do still get covered by insurance even though we are out-of-network.)
So, there you have it! I don’t take insurance because I want to be able to spend time with my patients and give them the care they need and deserve. When I’m not with patients, rather than battling insurance companies, I want to spend that time researching and creating more ways to help my patients and my community.