Unfortunately, Naturopathic Doctors in the state of California are considered out-of-network providers. Therefore, I would highly encourage you to give the number on the back of your insurance card a call to ask them whether or not you have out-of-network health benefits, and if so, what is your out-of-network deductible specifically (oftentimes the out-of-network deductible may be separate from your in-network deductible), what percentage of the visit cost is their responsibility to cover, and also whether or not you have any out-of-network benefits that are specific to lab / diagnostic testing. The reason it is important to distinguish between the out-of-network visits and the out-of-network lab testing is that oftentimes we need to order specialty lab assessments of body fluids other than blood through outside / specialty labs (e.g. stool / urine / salivary testing), and you may, in fact, be able to receive reimbursement for these labs from your insurance carrier, as well. If you find out that you do in fact have out-of-network benefits through your insurance, our office will provide you with a Super Bill, which will contain all of your ICD-10 diagnostic codes for each visit, as well as the CPT procedural codes. This way, your insurance provider will have everything they will require to reimburse you for the cost of each visit, as well as potentially specialty labs!
Some healthcare companies, such as Kaiser Healthcare, for example, do not offer their patients any type of out-of-network benefits. In cases such as these, one way that we are able to get the blood work that our patients need is to create a laboratory requisition form to have patients present to their in-network providers, so that they can ask them to be the “ordering provider” on their blood work. When your in-network provider is in fact the ordering provider, then your insurance is much more likely to cover the cost of the labs, as opposed to when an out-of-network provider is the ordering provider on your blood work. Although Kaiser providers used to be much more reluctant to order cutting-edge lab markers, many of them are becoming more open to ordering these blood markers for their patients because they have continued seeing that their patients are not improving, and they want to support them in finding the root cause.
The other option would be to see if your insurance is in-network with the lab performing the testing directly; if this is the case, then it will not matter whether an in-network or out-of-network provider orders your labs, your insurance will cover the cost of the labs because they are in-network with the lab performing your blood draw directly.
