Open enrollment season can feel overwhelming, especially if you rely on out-of-network providers, like our doctors at PIM. While California’s health insurance market offers many options, not all policies treat naturopathic care equally. With a little research and preparation, you can find coverage that maximizes your reimbursement and keeps your wellness care accessible. We hope you find the below tips helpful as you once again face open enrollment.
Know What You’re Looking For
When comparing plans, focus on these key features:
- Out-of-network coverage: Ensure the plan reimburses services rendered by providers who are not in-network.
- Reimbursement percentage: Many plans cover 50–80% of the allowed amount for out-of-network services. Higher percentages mean less out-of-pocket cost for you.
- Deductibles and annual limits: Some plans have separate out-of-network deductibles or lower annual maximums.
Research Companies Carefully
Some insurance companies tend to offer better reimbursement for naturopathic care than others. For example:
- Blue Shield of California – Offers partial out-of-network reimbursement depending on the plan.
- Anthem Blue Cross – Some plans cover out-of-network naturopathic visits.
- Cigna and UnitedHealthcare – Offer out-of-network options but coverage varies by plan.
Bonus Tip: Always check the plan documents or call the member services line to verify coverage before enrolling.
Know Which Codes Matter
When checking coverage, provide your insurance company with the CPT codes commonly used for naturopathic services. This helps determine if the services are eligible for reimbursement. Common codes include:
- 99205 / 98003 – New patient visits, in-office and telehealth (typically 60 minutes)
- 99215 / 99214 – Established patient visits (in-office)
- 98007 / 98006 – Established patient visits (via video)
- 98015 / 98014 – Established patient visits (via phone)
Bonus Tip: Always confirm with your insurance carrier which codes they cover for naturopathic care.
Ask About Reimbursement Process
Knowing your insurer’s (and plan’s) reimbursement requirements is important to maximizing your coverage:
- Check whether pre-authorization is required for out-of-network care coverage.
- Keep itemized receipts and CPT codes handy for claims submission.
- Ask if the plan allows direct reimbursement or if you’ll need to submit a claim yourself and get detailed instructions on HOW to submit a claim.
Compare Plans Side by Side
If you are choosing between plans at the same company, most websites offer a comparison option. If however you are comparing plans with different companies, make a spreadsheet or list of plans you’re considering, and include:
- Monthly premium
- Deductible (in-and out-of-network)
- Out-of-network reimbursement percentage
- Coverage caps
- Any requirements for pre-authorization
This makes it easier to see which plan best fits your naturopathic care needs. If you are short on time, you can use our pre-made comparison worksheet!
Don’t Forget Telehealth or Integrative Care Riders
Some insurers offer special coverage for complementary and integrative care, or telehealth visits with licensed naturopaths. These benefits can sometimes reduce out-of-pocket costs while still giving you the flexibility of out-of-network care. Be sure to look into your preferred plan’s telehealth coverage if you tend to see your PIM provider virtually.
Bottom Line
Finding the right insurance plan for naturopathic care takes some research, but it’s worth it. By checking reimbursement percentages, confirming CPT code coverage, and knowing the claim process, you can maximize your benefits while continuing to prioritize your health with Peninsula Integrative Medicine providers. Happy Open Enrollment Season!
