All Services
Karen Bergum, CST
Disclaimer – Insurance Coverage of Complementary Health Approaches
(*) Services that are typically covered by health insurance plans
Tips for contacting your insurance company about complementary health approach coverage
- Is this complementary approach covered for my health condition?
- Does it need to be:
- Preauthorized or preapproved?
- Ordered by a prescription?
- Do I need a referral?
- Do I have to see a practitioner in your network to be covered?
- Do I have any coverage if I go out-of- network?
- Are there any limits and requirements—for example, on the number of visits or the amount you will pay?
- How much do I have to pay out-of- pocket?
It’s always a good idea to keep records about all contacts you have with your insurance company, including notes on calls and copies of bills, claims, and letters. This will help if a dispute arises about a claim.
Do I have other payment options available if services are not covered by my health insurance plan?
- Flexible spending account: A Flexible Spending Account (also known as a flexible spending arrangement) is a special account you put money into that you use to pay for certain out-of-pocket health care costs.
Reference: https://www.healthcare.gov/have-job- based-coverage/flexible- spending-accounts/
- Health savings account: A type of savings account that allows you to set aside money on a pre-tax basis to pay for qualified medical expenses if you have a “high deductible” health insurance plan.
Reference: https://www.healthcare.gov/glossary/health-savings- account-HSA/
Per the IRS, these accounts will reimburse for the following Bhakti Services: Acupuncture, Chiropractic Care, Mental Health Care, Naturopathic Medicine, Occupational Therapy. Other Bhakti Services including Massage, Bodywork, Chinese Medicine, Energy Medicine, Medical Qigong, Herbal Medicine, Homeopathy, Postural Alignment Therapy, Micro Current Therapy may also be considered qualified medical expenses and reimbursable using your HSA or FSA when provided to treat diagnosed medical condition.
*Please consult your account vendor to confirm what services are reimbursable and under what circumstances.
You may also what to check with your health insurance plan to see if they offer any discount programs for complementary approaches.
If you’re choosing a new health insurance plan, you may want to ask the insurance provider about coverage of complementary health approaches. Some insurance plans cover selected complementary approaches by allowing participants to purchase special “riders”—or supplements—to their standard health insurance plans. Some offer discount programs, in which plan members pay for complementary approaches out-of- pocket but at a discounted rate.
Understanding Your Health Insurance Benefits
Your plan may encourage you to use in-network providers by charging you lower deductibles, co-payments and co-insurance amounts. The deductibles for in-network and out-of- network services may not cross apply (meaning you have separate deductible to meet). For example, you have a $500 in-network deductible and a $1,000 out-of- network deductible. Even if you have already met your in-network deductible so for all in-network services you only pay your co- insurance or copayment amount you would still need to meet your $1,000 deductible if you choose to see an out-of- network provider.
Out-of- pocket limit/max: the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses.
Co-payments: a fixed dollar amount (for example, $20) you pay for covered health care, usually when you receive the service.
Co-insurance: your share of the costs of a covered service, calculated as a percent of the allowed amount of the service. For example, if the health plan’s allowed amount for a 60-minute psychotherapy sessions is $100, your co-insurance payment of 20% would be $20. This may change if you haven’t met your deductible.
Allowed amount: the amount the plan pays for covered services. If an out-of- network provider charges more than the allowed amount, you may have to pay the difference.
Balance billing: amount your out-of- network charges for any amount not covered by your insurance plan. For example, if an out-of- network provider who charges $150 for a service and the allowed amount is $100, you would be responsible for paying the $50 difference even if your co-insurance for out-of- network services is 20% ($20).
Covered Services: services that your insurance plan will pay for also known as payable services.
Not Covered Services/Excluded services: services that your insurance company will not pay for unless either a request is submitted and approved or after a denial an appeal is approved.