One of the most common questions I get from new patients is, “Do you take my insurance?” It’s a great question, and one that shows how much healthcare has become intertwined with finances. The simple answer is: it depends. The journey to getting naturopathic care covered by insurance can feel a bit like navigating a maze, but I’m here to help you find your way.
As a licensed naturopathic doctor (ND) who accepts insurance at my clinic, Roots of Health, I’ve seen firsthand how confusing this process can be. Many people are eager to explore a more holistic approach to their health, but are held back by uncertainty about the costs. They wonder if the preventive, root-cause-focused care we provide is recognized by their insurance plan.
The good news is that insurance coverage for naturopathic medicine is becoming more common. However, it’s not yet universal. Your ability to get coverage depends on several factors, including where you live, your insurance provider, and the specifics of your plan. This guide will walk you through everything you need to know, from understanding the different types of insurance to the steps you should take before your appointment. I want to provide as much knowledge as I can about health insurance and naturopthic care. My goal is to help you make informed decisions about your health and finances.
Understanding Your Insurance Options
When it comes to paying for healthcare, not all insurance is created equal. The type of plan you have plays a major role in determining what services are covered. Let’s break down the most common types of insurance and how they typically handle naturopathic care. Typically, no matter what type of plan you get, insurance will only cover visits and lab work. Natural medicines, supplements, and herbs, even when prescribed, are never covered. For those expenses, you can use your FSA/HSA coverage (but we will get into that later!)
Private Insurance Plans
Private insurance plans are those you get through an employer or purchase directly from an insurance company marketplace. This category includes providers like Regence, Premera, and Lifewise, with which we are in-network at our clinic. These plans offer the most variability in coverage for naturopathic services.
Whether your private plan covers visits to an ND depends entirely on the specific policy you have. Some plans offer comprehensive coverage, treating naturopathic doctors just like any other specialist. Others may cover only certain services or have a limited network of approved naturopathic providers. It’s essential to check the details of your specific plan to understand what is included. Many of our patients at Roots of Health have success with these private plans, especially here in Washington, where naturopathic medicine is licensed and well-integrated into the healthcare system.
Medicare
Medicare is the federal health insurance program primarily for people who are 65 or older and certain younger people with disabilities.
Original Medicare (Part A and Part B) generally does not cover services provided by a naturopathic doctor. This is a significant gap for many older people who could benefit from a holistic approach to managing chronic conditions.
However, there is a potential workaround through Medicare Advantage (Part C) plans. These are offered by private companies that contract with Medicare. Some Medicare Advantage plans may offer additional benefits that Original Medicare doesn’t, including limited coverage for naturopathic care, acupuncture, or other alternative therapies. If you have a Medicare Advantage plan, you’ll need to check with your provider to see if visits to an ND are a covered benefit. Coverage is often limited and may require you to see an in-network provider.
Medicaid
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant individuals, older adults, and people with disabilities. These programs are administered by states, according to federal requirements.
Coverage for naturopathic medicine under Medicaid is quite limited and varies significantly from state to state. Only a handful of states with robust licensing laws for NDs offer any form of Medicaid coverage. For example, in Washington and Oregon, some Medicaid plans may cover services from a licensed naturopathic doctor, but this is not guaranteed. Patients with Medicaid should contact their plan administrator directly to ask about coverage for naturopathic visits.
HSAs and FSAs
What if your insurance doesn’t cover naturopathic care? You still have options. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are tax-advantaged accounts that allow you to set aside pre-tax money for qualified medical expenses.
The great news is that services provided by a licensed naturopathic doctor are typically considered a qualified medical expense. This means you can use the funds in your HSA or FSA to pay for your appointments, lab tests, and sometimes even supplements prescribed by your ND. This is a fantastic way to make naturopathic care more affordable, even if your insurance plan doesn’t offer direct coverage. Be sure to keep your receipts and consult with your account administrator to confirm eligibility.
Factors That Influence Your Coverage
So, why is naturopathic coverage straightforward for one person and complicated for another? Several factors come into play, creating a patchwork of coverage across the country. Understanding these can help you better predict whether your plan will cover your care.
State Licensing and Regulation
This is the single most important factor. Naturopathic doctors must be licensed to practice, and the laws governing licensure vary by state. Currently, over 20 states, the District of Columbia, and several U.S. territories have licensing laws for naturopathic doctors.
Insurance companies are far more likely to cover services in states where NDs are licensed and regulated. Licensing ensures that the provider has graduated from an accredited four-year naturopathic medical school and passed rigorous board exams. This gives insurance companies confidence in the provider’s qualifications. In states without licensure, it is extremely rare to find an insurance plan that will cover naturopathic care.
Your Specific Insurance Provider and Plan
Even within a state that licenses NDs, coverage is not automatic. Each insurance company sets its own policies. Some providers, like Regence and Premera in the Pacific Northwest, have a long history of working with naturopathic doctors and have established networks. Other companies may be slower to adapt.
Furthermore, within a single insurance company, coverage can vary from plan to plan. An insurer might offer a premium PPO plan that covers out-of-network naturopathic visits, while their more restrictive HMO plan does not. This is why you can’t assume that because your friend’s plan from a certain company covers naturopathic care, yours will too. You have to check your specific policy.
Primary Care Physician (PCP) Designation
Some insurance plans require you to designate a Primary Care Physician (PCP) to coordinate your care. In states with broad scope of practice laws for NDs, like Washington, Oregon, and Arizona, you may be able to designate a licensed naturopathic doctor as your PCP.
When an ND is recognized as your PCP, it often opens the door for broader coverage of their services, including routine check-ups, lab work, and referrals to other specialists. This is one of the best-case scenarios for patients seeking integrated care. If your plan allows this, it’s a strong indicator that your naturopathic visits will be covered.
In-Network vs. Out-of-Network Status
Just like with conventional medical doctors, insurance plans have a network of “in-network” providers they have contracted with. Visiting an in-network provider almost always results in lower out-of-pocket costs for you.
If a naturopathic doctor is “out-of-network,” your plan might still offer some coverage, but your deductible will likely be higher and your coinsurance percentage greater. In some cases, you may have to pay the full cost of the visit upfront and then submit a claim to your insurance company for reimbursement. At our clinic, we are in-network with several major providers to make care more accessible, but we always advise patients to confirm our network status with their specific plan.
Your Pre-Appointment Checklist
Feeling prepared before your first visit can make all the difference. Taking a few proactive steps can help you avoid unexpected bills and ensure a smooth experience. Here is my recommended checklist to complete before your appointment.
1. Contact Your Insurance Provider
This is the most critical step. Do not rely on information from a friend or a quick search online. You need to call the member services number on the back of your insurance card and speak directly with a representative. This is the only way to get accurate, up-to-date information about your personal benefits.
When you call, have your insurance card and information about the naturopathic doctor you plan to see. Write down the name of the representative you speak with, the date of the call, and a reference number. This can be helpful if you need to dispute a claim later.
2. Ask the Right Questions
When you have a representative on the phone, you need to ask specific questions to understand your coverage fully. Here’s a script you can use:
- “Is naturopathic care a covered benefit under my plan?”
- “Are services provided by a licensed naturopathic doctor (ND) covered?”
- “I would like to see Dr. [Name of ND]. Is this provider considered in-network or out-of-network for my plan?” You may need to provide the doctor’s full name, clinic address, and National Provider Identifier (NPI) number, which you can get from the clinic.
- “Do I need a referral from my primary care physician to see a naturopathic doctor?”
- “Is prior authorization required for any services?”
- “What is my annual deductible, and how much of it have I met so far?”
- “What is my co-pay or co-insurance for an office visit with this provider?” (Distinguish between specialist and PCP co-pays if applicable).
3. Understand Your Financial Responsibility
Based on the answers you receive, make sure you understand what you will be expected to pay.
- Deductible: This is the amount you must pay out-of-pocket before your insurance starts to pay. If you have a high deductible, you may be paying for the full cost of your initial visits.
- Co-pay: This is a fixed amount you pay for a covered service, such as $25 per visit.
- Co-insurance: This is a percentage of the cost you pay after you’ve met your deductible. For example, your insurance might pay 80%, and you pay the remaining 20%.
Understanding these terms will help you budget for your care and avoid any surprises when you receive your bill.
4. Be Prepared for Upfront Payment
Even with coverage, you should be prepared for the possibility of paying for your visit at the time of service. This is especially common if your provider is out-of-network, if you have a high deductible, or if you are using a government plan like Medicare or Medicaid.
If you pay upfront, the clinic will provide you with a detailed receipt, often called a “superbill,” which includes all the necessary codes for your visit. You can then submit this superbill to your insurance company to request reimbursement. While it requires an extra step, it allows you to see any provider you choose, even if they aren’t in your plan’s network.
Charting Your Path to Wellness
Navigating the world of health insurance can be daunting, but it shouldn’t be a barrier to receiving the care you deserve. By arming yourself with the right information and taking a few proactive steps, you can confidently explore how naturopathic medicine can fit into your healthcare journey.
Remember, the landscape is always changing, and more insurance providers are beginning to recognize the value of a holistic, preventive approach to health. Your voice as a patient matters. By asking for coverage and choosing plans that include naturopathic care, you are helping to drive the change for greater access for everyone.
If you are in the Seattle area and have questions about your insurance coverage or how naturopathic medicine can help you, please don’t hesitate to reach out to my team at Roots of Health. We are here to support you every step of the way on your path to optimal health.
