We gladly bill all insurance companies and are here to assist you in using your insurance to see our providers when applicable and fully utilize the services we offer.
Does your insurance company cover our services?
The best way to find out whether you are covered to see one of our providers is to have us do a benefits check for you, call today and we can check. The second best way is to also do one yourself.
Contracted Insurance Companies
Many insurance companies contract with healthcare providers in order to get you, the insured the best possible rate for your healthcare. We are contracted with all available insurance companies. Many insurance companies also offer a discount program. If you do not have a specific benefit you may be eligible for an additional discount on your visits. Here are a few of the insurance carriers who contract with us. This list changes frequently.
- Blue Cross Blue Shield
- CareOregon/Oregon Health Plan
- United Healthcare
Deductibles, non-covered services, pre-authorizations, prescriptions
Insurance can be confusing and the language used difficult to understand. A few basic definitions will help to avoid surprises, important when those surprises can have a weighty price tag!
What is a deductible?
Deductibles are amounts you have to pay toward your visits with a healthcare provider before the insurance company will pay. They are used to help reduce your monthly premium and can range from $100 to $10,000 a year. Ideally an insurance company will give you visits before your deductible applies to cover routine health exams and an acute situation or two. Some insurance companies categorize your healthcare as either sick & well visits and your deductible may be waived for one and not the other.
What is the difference between an in network and out of network provider?
If your insurance company utilizes network providers your deductible is often waived when you see an in-network versus an out-of-network provider. It is always best to have the healthcare provider you are seeing bill your insurance for you if they are in-network and you have a deductible because the insurance company may apply only the contracted amount toward your visit reducing the amount you have to pay.
Non Covered Services
Non-covered services are pretty self-explanatory, yet are not thoroughly explained in your benefit booklet. Many times an insurance company will cover office visits with your healthcare provider and not cover annual exams. They may cover your lab tests and not cover the actual specimen collection. Phone consultations and email correspondence are often non-covered services.
Pre-authorizations are most often used for complex imaging, procedures and some prescriptions. The most important thing to remember about pre-authorizations is that they take, at most, several days to determine if they have been approved.
Prescriptions are written by your healthcare provider and filled with a pharmacist. Your insurance company does not necessarily pay for all prescriptions and only rarely pays for vitamins & supplements recommended by your healthcare provider. Contact your insurance company for details regarding your prescription coverage.
Health Savings Accounts
Health savings accounts can be used to pay for amounts your insurance company does not pay. Many provide a debit card to pay for co-pays, other non covered health care expenses including vitamins and supplements prescribed at your provider’s office. Some are managed by your insurance company and will automatically cover non-covered amounts when claims are submitted for payment. The health savings account company may want receipts from amounts paid or correspondence from your healthcare provider explaining the medical necessity of the items submitted. Health savings accounts are made available by certain employers or can be set up by individuals privately with certain banks that provide a Health Saving Account service.
Accidents happen and we at The Center for Natural Medicine are here to help you recover from any injuries you have sustained.
In Oregon you can seek care with a Naturopathic Doctor, Chiropractic Doctor, Acupuncture and Massage Therapy under your Personal Injury Protection (PIP) coverage. When seeking Acupuncture and Massage Therapy treatment a prescription from a Naturopathic or Chiropractic Physician or other doctor may be required by your insurance carrier.
If you have a car, by law, you are required to have PIP coverage. In Oregon, your auto insurance provides a minimum of one year and $10,000 in no-fault medical coverage from the date of accident. You can be in your car or in another car. It will also cover you walking or on your bike if you are injured by a motor vehicle. If you have been in an accident involving a car and feel you need medical attention please seek the advice of a medical professional. Any medical provider you see will bill your insurance carrier for your visits up to the limit of your PIP coverage.
It is important to note that when you start treatment for injuries sustained in an accident, you will be contacted to settle your medical claim for a reduced amount from whatever your PIP coverage is. You will want to make sure all your treatment is complete and that all medical expenses have been paid before you settle in order to avoid owing more then what you settled for in an accident. If your treatment is complete you may have not fully recovered and may be left with a “permanent partial disability”. Insurance reimbursement for partial disabilities is usually best managed with the consultation of an attorney.
At this time we are not accepting worker’s comp insurance. If your work related injury is urgent, please go to your local urgent care. Otherwise, you can call an occupational health facility directly to schedule such as Providence Occupational Health (503) 216-7960.
If you (or your spouse) have contributed payroll taxes to Medicare throughout your working life you are eligible for Medicare when you reach age 65, regardless of your income or health status. If you choose not to sign up for Medicare at 65 you will be penalized and charged a penalty for each year you weren’t signed up, raising your premium upon, signing up.
When signing up for Medicare you will have the option of adding additional coverage in a Medicare Supplemental Insurance that does cover Naturopathic, Chiropractic or Acupuncture care depending on the plan you choose. There are plans that will only cover along Medicare guidelines and there are supplemental policies that cover above and beyond what Medicare covers. You will want to choose one of these policies if you see a Naturopathic or Chiropractic Physician, Acupuncturist or Licensed Massage Therapist. Insurance brokers can best guide you in choosing the Medicare Supplement Insurance that best meets your needs.
Contacting Your Insurance Company
The following are a few simple pieces of advice when contacting insurance companies regarding your benefits and coverage.
- Be prepared before calling your insurance company. If you have an insurance manual for your policy have it ready along with your ID numbers and insurance card.
- Always take and keep notes when talking with your insurance company about any specifics regarding your coverage and benefits. Write down the date, time of the call and the names of people you speak with giving your benefit details.
- Listen at the beginning of the call and check whether the phone call will be recorded, this is a good thing and can help sort out any miscommunications in the event that inconsistencies arise between what was said and what was done.
- If a reference number is given for the call write it down as well, it can be used to trace your conversation and help in the event you need to follow-up on an inquiry.
- Utilize your insurance companies website. They are getting quite good with personalizing information, especially if you are able to create your own login and account. Insurance company websites don’t always have all the information you need. Make sure to check any specific details you may need by calling them to confirm a healthcare provider you want to see is in-network or a procedure/service is covered by your plan.
Do you treat uninsured individuals with no insurance or limited income?
Many of our providers offer payment plans to qualified individuals. Beyond our 10% time of service discount, our Community Teaching Clinic medical student teaching shifts offer general medical services at a deeper discount. Consultations are discounted 50% and in-office procedures are discounted 20% off of Dr. Milner’s usual office fees. This discount excludes any products purchased from the dispensary.
As a member of National College of Natural Medicine (NCNM’s) Community Clinic program, Heart and Lung Wellness also offer care to the uninsured, unemployed and underemployed members of the greater Portland area community for $20 per visit. If you are not insured and/or unemployed or can’t afford the healthcare you need call us at 503.232.1100 (dial 0 for our receptionists) and we can determine if you qualify over the phone.