As a courtesy, we will bill insurance for you. Your health insurance covers the functional medicine consults but not the membership fee. An FSA or HSA may cover that cost and supplements too. As for the testing some insurances like Medicare cover some of the cost and commercial insurances may or may not cover some. Medicare with certain supplemental plans may cover all the tests.
Please check yearly with your insurance to see if I am an In-Network for your specific plan. Let use know if you need assistance. Health insurance companies offer large numbers of plans and can change physician in-network status each year. If your insurance is not listed then please use your consumer influence and call them to add me. I may bill other out-of-network plans for you. If you’re without insurance, I offer a 30 % discount for same day payment via cash or check.
Also note that even if I am in your insurance network, that is not a guarantee of benefits or payment by your insurance company. The insurance companies have declared that all services are subject to any limitations or exclusions that are in effect at the time you or your family member receives services. You will remain responsible for any charges not covered by your insurance and you will be billed for these charges once your insurance has processed the claim which may take up to several weeks.
Payment of outstanding charges is due within 30 days of notification. If payments have not received for outstanding balances by 30 days, a $15 fee will be added to your account, and will be added again for every 30 additional days the account remains unpaid in full. If you are suffering financial hardship, please contact me directly well in advance of the 30 day period, and we can negotiate a payment plan with waived late fees.
A fee of $30 will be imposed for a bounced check.
Please check yearly with your insurance to see if I am an In-Network for your specific plan. Let use know if you need assistance. Health insurance companies offer large numbers of plans and can change physician in-network status each year. If your insurance is not listed then please use your consumer influence and call them to add me. I may bill other out-of-network plans for you. If you’re without insurance, I offer a 30 % discount for same day payment via cash or check.
Also note that even if I am in your insurance network, that is not a guarantee of benefits or payment by your insurance company. The insurance companies have declared that all services are subject to any limitations or exclusions that are in effect at the time you or your family member receives services. You will remain responsible for any charges not covered by your insurance and you will be billed for these charges once your insurance has processed the claim which may take up to several weeks.
Payment of outstanding charges is due within 30 days of notification. If payments have not received for outstanding balances by 30 days, a $15 fee will be added to your account, and will be added again for every 30 additional days the account remains unpaid in full. If you are suffering financial hardship, please contact me directly well in advance of the 30 day period, and we can negotiate a payment plan with waived late fees.
A fee of $30 will be imposed for a bounced check.
Insurance Coverage For Functional Medicine Testing
Some do cover the cost of the functional medicine tests and I may provide you with the CPT test codes and you may look up your ICD 10 diagnostic codes needed to ask your insurance. Medicare, and not always the Advantage plans, covers about 3/4 of the total functional medicine test kits cost and some supplemental plans seem to cover the rest of the expense.
Some do cover the cost of the functional medicine tests and I may provide you with the CPT test codes and you may look up your ICD 10 diagnostic codes needed to ask your insurance. Medicare, and not always the Advantage plans, covers about 3/4 of the total functional medicine test kits cost and some supplemental plans seem to cover the rest of the expense.
I N S U R A N C E P L A N S i n N e t w o r k
Medicare. Most Medicare Advantage plans too.
AETNA
STANDARD plans:
Aetna Affordable Health Choices (SRC only);
Aetna Voluntary plans:
Elect Choice EPO; Managed Choice POS;
Open Choice PPO / Open Access Plans: Choice POS II (Open Access);
Select (Open Access); Elect Choice EPO (Open Access);
Managed Choice POS (Open Access) / HealthFund Plans:
Choice POS II; Open Access EPO & POS; Open Access Select;
Open Choice PPO / Premier Care Network: APCN POS II;
APCN Open Access Aetna Select / Innovation Health: Innovation Health Aetna Select;
Innovation Health POS; Innovation Health PPO / National Advantage
Medicare Choice Plan PPO; Medicare Elite Plan HMO; Medicare Select Plan PPO; Value Plan HMO; Coventry
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CIGNA:
Open Access Plus, Choice Fund OA Plus W/CareLink, PPO, OA Plus & Choice Fund OA Plus, Choice Fund PPO
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COVENTRY/FIRST HEALTH: Coventry National Network
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FIRST CHOICE HEALTH: All networks
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MODA: Beacon, Connexus, Synergy, not Legacy currently, hopefully soon
**Medicare Advantage -- expected effective date of 01/15/2024
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MULTIPLAN/ PHCS
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PACIFICSOURCE:
Billings Clinic Employee Health Plan , Medishield PSN, PSN, BrightPath , Prime, SmartAlliance
SmartHealth (Idaho, Oregon & Montana Members) SmartChoice UO Student Health Plan (tier 2)
Not Legacy- they say they have enough providers
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PROVIDENCE:
Signature Networks
MedAdvantage Networks
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REGENCE BLUE CROSS BLUE SHIELD BCBS of Oregon & other states:
Oregon Preferred, Classic, Innova, Engage, Evolve, HSA (2.0,3.0)
Oregon ActiveCare, Platinum, Gold, Silver, Bronze
Clark County Preferred, Classic, Innova, Engage, HSA (2.0,3.0)
Clark County ActiveCare, Platinum, Gold, Silver, Bronze
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UNITED HEALTHCARE:
Charter/ Charter Balanced
Charter HMO/ Charter Balanced HMO/ Charter Plus HMO
Charter Plus
Choice
Choice HMO
Choice Plus
Choice Plus with Harvard Pilgrim
Core
Core Essential
Core HMO/Core Essential HMO
Heritage Plus
Heritage Select POS/HMO
Heritage Select EPO
Navigate HMO/Navigate Balanced HMO/ Navigate Plus HMO
Options PPO
Select & Select Plus
Signature Value MCO
Medica Choice with UHC Choice Plus
Oregon Medicaid (Open Card)- CLOSED, may be added to waiting list