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In the world of insurance there are many types of plans, from
catastrophic, which only covers emergencies, to full coverage
and everything in between. The first thing you need to know
is what type of plan you have. Is it an HMO type plan, which
dictates that you pick a 'Primary Care Provider' (PCP)? That
PCP then must coordinate referrals for all other types of
providers and services. Or, do you have a PPO plan, which
more often allows you to see whomever you want, referral or
not? Your insurance card should show which type of plan you
have. Explore your company’s website and your insurance
booklet they usually send you yearly to first learn about
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 here. However, they 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 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 you need a referral?
- Is there a deductible?
- Do you have a limit on the number of visits you can have per year?
- Is there a monetary cap on your 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 rep 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.
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5312 Roosevelt Way NE, Seattle, WA 98105 Copyright © 2007
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