Insurance and Fees

Insurances Accepted*

*Please always call your insurance company to be sure your provider is in-network and that you have naturopathic benefits. We are not able to check individual patient eligibility and coverage. This table is created to the best of our ability and current knowledge, but coverage and eligibility is up to the patient to confirm. 

**As a resident, Dr. Gilman, is overseen by Dr. Krystal Richardson and therefore visits are billed through Dr. Richardson. He may not be shown as in-network when looked up individually with insurance companies. 

Cost of Visits

Cost of visits are based on the time spent with a provider, the complexity of the visit, and the amount of work post visit that the provider provides (records review, patient research) so we are not able to provide an exact price quote prior to the visit. Below is the range of prices for specific visit types. Please be aware that if you see a provider for a wellness visit and included in that visit is discussion about particular concerns you might get a bill for both the wellness visit and a problem focused visit (this is dictated by insurance and even though you might not be using your insurance benefits we are still required to uphold these rules based on our contracts with insurances). 

* We provide a 20% discount for all time of service payments (prices listed do not reflect this discount). 

**If you have not been seen in the clinic for 3 years you are automatically classified as a new patient. 

NEW POLICY NOTICE: This new policy will apply to all future balances as well as any outstanding balance as of January 1, 2023. All copays, dispensary costs, time of service charges, non-covered services, client billing lab fees, in-house medications, and current outstanding balances on file will be charged to the card on file after any appointments (both in person and video). When you receive an invoice from us to your CHARM PATIENT PORTAL you will have 30 days to pay the invoice before the card on file is charged. This can include, but is not limited to, supplements, lab fees, medication costs, visit costs, copays, co-insurances, deductibles, and any charges that insurance designates as patient responsibility. If you do not have an active card stored on file or if the payment does not go through, then it will be your responsibility to pay your invoice via the CHARM PATIENT PORTAL within 30 days of receiving the invoice. If we don’t receive payment in 30 days you will receive a paper invoice notifying you of the past due amount. If payment is not received within another 30 days then a $25 late fee will be added to your invoice. There will be no exceptions to this. If payment is not received within 90 days of invoice notification (or another arrangement have not been made) you will be sent to collections.

Cancellation Policy

When scheduling a visit with one of our providers, please be sure that you select the correct clinic location and have checked with your insurance that the provider is in-network for you and that you have naturopathic benefits. In addition, please be advised that we have a $75 no show fee or late cancellation fee (less than 24 hours). 

If you need to cancel your appointment, 24 hours’ notice is required in order to allow time to fill the empty appointment slot. If you do not give 24 hours’ notice, you are liable for a cancellation fee of $75. Exceptions to this policy will be considered on a case-by-case basis.

Why the fee? Our doctors spend 30-60 minutes per patient. They only see 8-12 patients / day. Please respect the considerable amount of time they have set aside for you. If you cancel your appointment inside the 24 hours notice requested or do not show up for your appointment then this prevents someone else who needs medical care from filling that open slot. 

Non-Covered Services

Your insurance may not pay for all of your healthcare costs. Some items and services may be considered “non-covered benefits” under your health insurance plan and as such, your insurance will not pay for these services. 

If your provider believes that the following service(s) are an important part of your care, and they are considered “non-covered services” by your insurance plan, you will be charged for them at the listed fee below. The purpose of this notice is to help you make an informed choice about whether or not you want to receive these items or services if your provider recommends them to you today. 

List of Non-Covered Services: 

More Information about Insurance Benefits

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

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

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

In-Network

In-Network 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

Out-of-Network 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 an annual deductible feature, which means that every calendar year you must pay a certain initial portion of your medical bills before the insurance company will cover anything. In some plans the deductible is small, requiring you to pay the first $200-500 of each year’s medical bills. 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.

Benefits

Benefits is a term that refers to what you get coverage for. In other words, if your plan will pay for acupuncture, your insurance company will say that you have acupuncture “benefits.” The term is also used when referring to amounts of coverage that you have. For example, if your insurance company will only pay for $500 worth of alternative medicine it is said that “your benefits have been exhausted” when you have used this amount up.

Co-pay

A co-pay is the dollar amount that the insurance company requires you to pay each time you visit the doctor. Co-pays generally range from $15-55 these days and are paid at the time of the doctor visit. Co-pays are often higher for emergency room visits compared to doctor’s visits.

Co-insurance

Co-insurance is usually a percentage of the medical charges (doctor’s or lab charges for example) that the insurance company makes the patient pay. The Co-insurance is separate from the Co-pay. This is confusing to some people especially if they also have both a co-pay and co-insurance, or if they used to have 100% coverage in the past. Few plans cover 100% now, and it is becoming more common for insurance plans to require patients pay a co-pay at the time of the doctor visit, and then pay a portion of the remainder of the doctor’s bills at a later date (co-insurance).

Explanation of Benefits (EOB)

An Explanation of Benefits is a statement that the insurance company sends to the patient and to the doctor. Also called an EOB, this statement is sometimes quite clear and other times confusing. It shows the doctor’s or clinic’s charges for the various procedures or services provided to the patient. If your doctor is a preferred provider (i.e. “signed up with”) that insurance company, then the doctor’s payments are usually “adjusted” (i.e. lowered) in the next column. The next column of the EOB usually will show how much money the insurance company is going to pay the doctor and how much money they expect the patient to pay the doctor. They usually call this the “patient responsibility.” The EOB will sometimes indicate why the patient owes the money (i.e. that the patient’s portion is applied to the deductible, or that it is co-insurance). Increasingly, the percentages that the patients are responsible for is increasing.

Delay in doctor’s billing

Some people are confused when they receive a bill from a doctor months after the visit. They feel that too much time has passed and that there must be a mistake. Of course, a mistake is always possible, but the reason for the delay is usually this: the doctor sees the patient and sends a bill to the insurance companies. This bill is called a HCFA form and contains codes for the procedures, the diagnoses and the doctor’s charges. The insurance companies can take 30 days or even months to pay the doctor for her charges. When the insurance company pays the doctor, it sends an EOB to the doctor and the patient. If the EOB indicates that the patient is responsible for a portion of the doctor’s charges, then the doctor’s office will generate a bill for the patient. Since many small doctor’s offices send out bills only once per month, it may take a while before a patient receives the bill from the doctor. Please be aware that you should receive an EOB from the insurance company explaining what you owe and that the decisions about what you owe are generally made by the insurance company and not the doctor’s office.

Primary Care Provider (PCP)

Some insurance plans require you to have a main doctor responsible for coordinating your medical care and deciding which specialists you can see (i.e. referring you to specialists). On some plans, you need to specify your Naturopathic Physician (ND) as your primary care doctor and others do not require you pick a specific PCP. 

Referrals

Many plans require a referral to see a specialist. In some cases, your insurance may not require a referral, but the specialists office does. If you need a referral to see a specialist or other healthcare provider, it is best to get the referral before you visit the specialist. To get a referral please schedule a visit/examination with your PCP to document medical necessity for the referral (this is important for insurance purposes). 

Preventative Medicine

Preventative medicine refers to medical services that are not targeted at a specific disease. It includes care designed for screening an apparently healthy person for disease (for example, yearly physical exams, screening blood work, and PAP smears) or for discussing how to avoid disease or improve health to “optimal,” such as with dietary or lifestyle counseling. If you discuss any other concerns with your provider at the time of a preventative/ wellness visit there will be additional codes applied to the visit (as mandated by insurance). These additional codes are not considered preventative and may be subject to deductible, copay, and coinsurances. 

Medical Necessity

Medical necessity refers to specific medical “need” or “appropriateness” of the procedure provided by the doctor. It is up to the insurance company ultimately to decide what is medically necessary and what is not. As doctors we have some say in this, but the ultimate decision is up to your insurance provider.  

Prescription referrals

Some referrals do not need to be pre-approved by the insurance company, but a doctor must prescribe the visit or treatment. For example, some plans will pay for you to see a massage therapist with a prescription from a doctor. However, the prescription for massage must be medically necessary, in other words, it must be prescribed for a specific health problem typically thought to respond to massage. Insurance companies generally will not pay for massage for relaxation. If you require a prescription referral for massage, acupuncture, chiropractic care, or other please schedule a visit with your doctor to discuss this need and document medical necessity (for insurance purposes). If you are requesting a prescription referral for a condition that has not been discussed in the last 6 months you will need to schedule a visit prior to the prescription being provided. 

Flexible Spending Account

These accounts are usually set up by the patient’s employer. Both the patient and employer can make contributions to the account. The contributions are protected from taxes. The patient brings receipts from their medical expenses (co-pays, coinsurance, medicines, deductibles, prescribed supplements, and out of network lab bills) to be reimbursed from the fund by the administrator of the fund. Any money left in the flex spending account at the end of the year is lost to the patient, so you should try to determine how much you think you will spend in advance of setting up the account each year.

Health Savings Accounts

These accounts can be set up by the patient and/or their employer. The money in these accounts can be less than or equal to the patient’s annual deductible and is used to pay for medical expenses (deductibles, medications, etc) incurred by the patient each year. The money withdrawn from the HSA is exempted from income taxes. Any money left unused in the HSA at the year’s end can be rolled into an Individual Retirement Account and therefore is not lost to the patient.

We hope this information we provided helps you to understand your insurance coverage. You are the one who is responsible for your coverage so arming yourself with knowledge is the best plan!

We hope this information we provided helps you to understand your insurance coverage. You are the one who is responsible for your coverage so arming yourself with knowledge is the best plan!

Sliding Scale

We have a sliding scale application available to patients who do not have insurance or have insurance that our providers are not in-network with. Please inquire with us directly if you would like to apply for sliding scale services. We offer a 50% discount to patients who have Medicaid insurance or an Apple Health Plan. 

Standard Office Visits

Visits with our providers are based on standard medical coding for evaluation and management, which involves both complexity of the case and time spent with the patient. In addition to the office visit, there may be additional fees for blood draws, vitamin injections, in-house lab testing, outside lab fees, etc. These fees are generally between $20 and $60. Fees for services are due at the time of service.

Preventive Office Visits

Well-child exams, annual wellness exams, and sports physicals are coded differently from standard office visits, and are based on the age of the patient and whether you are a new or established patient. If there are additional concerns brought up at these preventive office visits, there will be an additional brief office visit fee.

Pager Fees

As a courtesy to our patients, we have an after hours call line available for calls outside of business hours. Please note that there is $75 pager fee per call, which may be waived in certain circumstances by the physician on call. This line is only available to our existing patients. We make every effort to call patients back within 15 minutes, but sometimes life does not allow the provider to get a message in that time frame. If you are not able to wait for a call back we ask that you please seek care at an urgent care or ER (as warranted). To reach our after hours line please call the main office phone number and pick the option to be transferred to our after hours phone. 

Video Consults

We see a large number of patients through video, but please keep in mind the doctor may need to see you in-office for a proper diagnosis and treatment of a condition. It is up to your doctors discretion to decide if you need to come in for an in-person visit. If the in person portion of a video consult is on the same day your insurance will not be billed for two separate claims. If the in person visit falls on a separate day from the video visit then a separate claim will be sent into insurance. Telehealth visits are carried out through our electronic health records system Charm and uses Zoom as the platform. This ensures that the telehealth visit is Hipaa compliant. If your doctor is running late, please stay in the Zoom waiting room and your doctor will join you as quickly as possible. If your doctor is on the Zoom call and not connecting with you they will call you to troubleshoot any technical issues that may have arisen. 

Dispensary

We have a small high quality supplement dispensary available to our patients for herbal and nutritional supplements. As a patient, you can purchase prescribed supplements tax-free. Insurance does not cover supplement purchases, but patients are able to use a pre-tax health savings account (HSA) or a flexible spending account (FSA) to buy prescribed supplements. We also have a mail order dispensary program with free shipping. If you are in need of a refill of your prescribed supplements please send a message through the Charm Patient Portal to our dispensary department. Please include the name of the supplement and quantity in the bottle. Be sure your address is up to date in our system and please let us know if it is okay for us to charge the card on file or if you would like us to send an invoice to your Charm patient portal for payment. 

Refill Requests for prescription medication

We ask that patients allow 48-72 business hours for refill requests to be processed. We often receive urgent requests for a refill, such as forgetting to take a medication on vacation, and we do charge a fee for those requests. 

Urgent request (requiring a refill <48 hours) is $35. 

We require all patients to come in at least once a  year in order to continue to get refills on medications. However, certain medications and conditions require more frequent visits and monitoring so your doctor may require visits every 1- 6 months in order to continue to refill your medications. That is up to the discretion of your doctor.