INSURANCE COVERAGE AND NATURAL MEDICINE

In WA State, we are very lucky to have some insurance coverage for natural (“alternative” or “complementary”) medicines. This is because of a law called the “Every Category of Provider Law” that was introduced by a champion of natural medicine, Debra Senn, when she was Attorney General in Washington. This law states that insurance companies who operate out of Washington State must offer insurance coverage for alternative care providers as well as for conventional medical providers.

There are some exceptions to the law, of course. If an insurance company does business in WA but is not based here they do not have to comply. If your employer has headquarters outside of WA State they may not have to comply. Some insurance companies from other states do insure businesses in WA State and offer alternative medicine coverage, as long as the provider is licensed in the state of WA where they provide care. Other out of state insurers do not offer coverage for any alternative care of they only cover certain types of providers, for example, they may only allow acupuncture or massage but not naturopathic medicine.

If an employer creates and buys “self insured plans” from an insurance company then they are expected from the every category of Provider law. Several large corporations chose to “self insure” and have limited access to alternative providers in their insurance packages.

Some insurances companies offer plans to employers that limit on how much money the insured can spend on alternative care. Other insurances plans limit how many visits you may make to a type of provider (for example only 12 acupuncture visits). Another thing that might occur is a separate deductible for alternative medicine.

To better understand your insurance benefits, some insurance terms and experiences you should familiarize yourself with include:

In-Network: This term refers to providers of medical service (doctors, clinics, hospitals, laboratories) that are signed up with the insurance company. There is generally an application and approval process. The providers are then termed “in-network” or “preferred providers” by the insurance companies. The preferred providers generally agree to accept lower rates of reimbursement decided upon by the insurance companies.

Out-of Network: This means that a provider such as a doctor or lab is not a preferred provider with your plan. Coverage depends upon your individual plan and may range from zero to partial. Some plans will provide significant coverage once you pay an out-of network deductible, i.e. a certain amount of the initial out-of-network doctors’ bills.

Annual Deductible: Many plans have this feature, which means that every calendar year you must apply a certain initial portion of your medical bills before in the insurance company will cover anything. In some plans the deductible is certain initial portion of your medical bills before the insurance company will cover anything. Some plans the deductible is small, requiring you to pay the first $100-500 of each year’s medical. Catastrophic plans have higher deductibles such as $1,000-5,000 yearly. Once your yearly deductible is paid then the insurance company will begin paying for some or all of your medical bills. When the calendar year is up, you are responsible for the annual deductible again for the New Year.

Some insurance companies have several individual plans. Just because you and a friend might have the same insurance, doesn’t mean you will have the same benefits/eligibility. Always, call and verify with your insurance company.