Insurance News Update

Insurance and You

Blue Cross Blue Shield- I passed!

I am now an in-network provider for BCBS of Vermont as a primary care provider (PCP). I am not considered a specialist in BCBS. This designation limits eligibility for some. We, meaning VANP (Vermont Association of Naturopathic Physicians), continue to work on getting a "specialist" designation with BCBS. I will keep you posted.

For all eligible patients, I will bill BCBS for your office visits. Eligibility depends on your plan and referrals. If I am selected as your PCP, then you are definitely eligible. Please read the "Insurance Low Down" below for more information and explanation about eligibility within plans.

Patients will be responsible for copays and the cost of supplements. Additionally, certain tests ordered remain uncovered by insurance and require payment up front. Visits will need to be paid in full if your deductible has not been met. Please provide your insurance information when you schedule your appointment so that things can proceed as smoothly as possible. This is a great gift, hard-won by all. I want to utilize this new gift as much as possible without compromising care. Commercial insurance does not always cover the way a naturopathic visit occurs.

Specifically, insurance reimbursement rates may limit the time spent in an appointment. One of the things that people enjoy most about visiting me is I take the time to listen and to get the whole picture. Unfortunately, Insurance companies don't seem to have a code for this important process. Maintaining excellent care may require extra out of pocket costs for you for the time spent listening, counseling, and explaining treatment plans and lab results in detail. I will always let you know when we reach that point so that you can decide how to proceed. I will do my best to juggle being an in-network provider for insurance and being a holistic, mind-body practitioner.

CIGNA

I am currently in the process of applying to CIGNA as a specialist. As a specialist anyone can see me with or without a referral depending on your plan, see "Insurance Low Down". I will let you know when my application gets accepted.

Visits

Of course I will continue to see patients regardless of their insurance status. I will continue to offer a "paid at time of service" discount for office visits. In addition, I offer a 10% senior discount to those aged 60 years and older. For individuals without BCBS or CIGNA, I will provide you with a bill with all of the necessary information needed for you to submit your own claim. Again, all Vermont insurance plans are required to cover Naturopathic office visits as of October 1st, 2007 (Some may wait until Jan. 1, 2008 to implement into their plan). You would submit the bill as an out-of-network expense.

VHAP

Recently I sent out a newsletter about how VHAP does not fall under the recent bill. It looks like the legislators will get that ironed out in January 2008. I will let you know when the final results come in.

Health Savings Accounts (HSA)

You may continue to use your HSA to pay for copays, office visits (non-insurance, deductible not met), and supplements. Remember, the money placed in your HSA rolls over to the next year. See Newsletter Fall 2006 for more information.

Labs

As of Monday October 29th, 2007 all lab requests billed to BCBS need a valid BCBS provider number. Happily, because I am now a provider, you have nothing to worry about. Labs ordered by non-participating providers will not be covered by BCBS. Again, check with your plan details for more information.

Insurance Low Down

HMO

HMO plans require you to choose a PCP and have a referral from your PCP before seeing any specialist. My services will not be covered by those with an HMO who don't choose me as their PCP or who don't have a valid referral from their PCP. I will bill all BCBS members regardless. However, those without verified eligibility will be required to pay in full for their visit.

PPO

PPO plans do not require a referral from your PCP before seeing a specialist or other PCP. You get to decide who you see and when. If the physician you choose is not in your network, you may have to pay more. Check your plan for reimbursement of in-network and out-of-network care. PPO plans often offer a similar deductible for both in and out-of-network providers. Always check on your deductible status before your appointment.

Other

Cigna's other plan, "Open Access Plus", usually has a very high deductible. Most often visits will not be reimbursed because they will be applied to the deductible. Again, check in with your plan for benefits and your current deductible.

Most plans do not include phone call coverage. Any calls longer than five minutes will be your responsibility (explained in the "Acknowledgement and Fees" form). Calls lasting less than five minutes, i.e. questions about recent treatment plans, remain free of charge.