|
The world of insurance works with the rule “medically necessary.” All credentialed providers must sign
a contract to abide by this rule. This means we will not bill your insurance company for services that
are not medically necessary to benefit your immediate health. An example of this is counseling in
regards to wearing a seat belt versus checking blood sugar in a diabetic patient. One is guidance for
the future, to prevent illness. The other is an immediate need to maintain health. Most plans provide
for at least one preventive health visit a year such as an annual physical/gynecological exam. Other
visits are strictly for illness only. This doesn't affect most of our patients who are coming in with existing
health concerns. It does affect those patients who want to live beyond the mean and not be just free
from an illness…patients who want to learn how to be their healthiest and live optimally. While
insurance does not generally cover these types of visits, we strive to make it the most affordable and
be the best money you have ever spent.
Are alternative medicine services covered by your plan?
The next issue that arises is more specifically about “Alternative” medicine, the category most
Naturopaths and Acupuncturists fall into. While both Drs. Donovan and Fahoum at the UHC are primary care
physicians for most major insurances in the State of Washington, not all plans allow us to have that status. It
is a law in Washington State that “every category of provider” be covered by all insurance
companies operating in the state. However, those companies must only offer at least ONE plan that does so.
This is why it is imperative that you understand your own benefits. Even if we are not considered PCP's you
may still be able to see us as specialists with a referral.
So how do you call your insurance company and find out? First, you will probably need the specific
practitioner's name, George Whiteside, L.Ac., Dr. Monawar Fahoum or Dr. Patrick Donovan for examples.
Then you will need to specifically ask if these practitioners are covered by YOUR plan. From there, you want to
ask:
Do I need a referral?
Is there a deductible?
Do I have a limit on the number of visits allowed per year?
Is there a monetary cap on my benefits for a given year?
Sometimes you can only see an Acupuncturist or Naturopathic physician for certain types of visits or certain
diagnoses. If this happens, the customer service representative will probably ask for specific codes before giving
you the information you want. Go to the medical code page or
call our office if you need help with this.
|
5312 Roosevelt Way NE, Seattle, WA 98105 Copyright © 2007
|
