Working Wellness Around the “System,” part 6

posted in: CYJ Blog, Lifeskills, Wellness

Hi Doc…BTW, Is This Covered by Insurance?

Now that you have done your homework and have answers to the insurance questions offered in the previous article (part 5), it’s time to see how practitioners handle insurance, or not. Again, when you start calling integrative/CAM providers, make sure you write down who you talk to and what they say, should any care or coverage issues arise in the future.

Some providers may know the answer to the insurance questions posed in the previous article. Yet, I would still double-check with your insurance company. If you already have a primary-care physician, I would begin by asking if they are willing to recommend an integrative (IM) or CAM provider as part of your treatment plan. You never know unless you ask, right?

Once you make an initial connect with an integrative/CAM provider first ask the same questions posed to your insurer. Then ask the cost for first appointment, follow up appointments, and any sliding scale based on income. Always ask if the provider is willing to negotiate fees, even a payment plan, or offer discounts to cash-paying customers. Also, how many appointments will you likely need? Do they accept your insurance plan, and what has been their experience with your plan’s coverage for people with your condition? Find out if you file the claims or your provider takes care of it. For the best coverage outcomes, your provider will need experience in handling insurance claims, particularly diagnostic codes, or at least offer advice for you submitting the claim.

As with any doctor, working with an integrative or CAM provider is often a grand therapy experiment, even with appropriate testing and monitoring. One has to just see how the body responds and adjust accordingly the medicines, nutritional supplements, eating routines, and any other prescribed therapies. It means you need to keep on keeping on, learning on your own as you work in partnership with your providers.

You will also need to make sure you have some extra cash on the side saved for any therapies not covered by insurance. It was fairly easy for me since I couldn’t really dine out for many years and had to create my own recipes from scratch and on rotation in order to monitor what I was eating to avoid any digestive, allergic, or sensitivity reactions.

The National Center for Complementary and Integrative Health (NCCIH) recommends you “. . . keep records about all contacts you have with your insurance company, including notes on calls and copies of bills, claims, and letters. This may help if you have a claim dispute.” I would do the same with your providers as well.

Put together a wellness notebook binder with copies of everything, including test results, medicine and supplement list, contact information on all your providers, questions you want to ask, and any outcome notes. Write down your life/wellness goals and put it at the front of the notebook as a reminder of your commitment to yourself and your family. Be sure to also complete a Patient Authorization to share health information with all other providers as part of your wellness team. Your permission will allow each provider to send copies of any test results and prescribed treatments to everyone you put on the permission form. Providers rarely communicate with one another, particularly between conventional and integrative or CAM. You are center-stage to make that happen.

The next and final article for this series (part 7) will focus on the bottom line: Was it worth the bucks?