Does insurance cover naturopathic doctors? Here’s what you should know.
by Yoojin Lee-Sedera, N.D., O.M.D.
Here's the truth about health insurance that no one talks about.
As a health care provider and a physician, one of the most common questions I get from people is, “does insurance cover naturopathic doctors?”. Many people pay a hefty premium every month for their health insurance. In return, they expect their insurance to cover services that are important and necessary for their healthcare. Unfortunately, many people realize that it is not the case when they try to use it for a service they believe is vital to their health. Their insurance says, “it is not medically necessary”. But what does that mean? And why is that? Is your health insurance company a villain? Does it mean that health insurance isn't necessary? Whose responsibility is it that people are not getting the healthcare they need?
Ever since I started practicing medicine, this has been a big dilemma that I’ve been thinking about for a while. So, let me share my own perspective based on my experience over the years.
So, why isn't wellness care covered by some health insurance companies? Let’s rephrase this question - what is covered by most health insurance?
First, you go to see your doctor when you’re not feeling well. Typically, people don’t think of going to see the doctor unless they think they feel something is wrong, and in order for the insurance to cover the visit, there must be a good reason. Next, the doctor will order a "relevant" test or two so that they can find out what condition you have and “diagnose” you. Based on that diagnosis, now the doctor can prescribe you a medication or other “relevant” treatment. This whole process is based on insurance protocol, even the medications and other treatment options. There is a list of prescription medications that insurance will cover for certain conditions, but there also are lists of “allowed” tests that doctors can run to come up with certain diagnoses. So, what’s wrong with that? When doctors have to follow protocols exclusively provided by insurance companies, there is no room to consider individual differences often necessary to maximize health benefits.
If you and someone on the other side of the country share the same diagnosis, regardless of your background, history, living situation, or various symptoms, you get prescribed the same medications.
Do naturopathic doctors take insurance?
“But, I’m different from that person!” you may say. Unfortunately, that doesn't really matter to most insurance companies. You still need to go through the same process, step by step, even with the list of medications, until you find the one that might work for you. This is also why doctors can't really help you unless a specific test shows something abnormal, regardless of how you actually feel. Without the proof of the test result, you don’t have a “diagnosis” or condition that can be treated.
Again, I’m not saying the protocol is wrong. Every business has its own protocols to keep their business running - and health insurance is a big business. What we often miss is the understanding of the true position of the health insurance industry.
Although they have one foot in the healthcare industry, their root is in the finance industry. Just like other insurance businesses, they are financing companies.
The original purpose of health insurance was to prepare people financially for unexpected health crises, such as accidents or major surgeries or treatments necessary to stay alive, not to help people achieve better health overall. That’s why these companies put such a strict limit to what is “medically necessary” when it comes to choosing your test or treatment relevant to your condition.
How do these insurance companies decide what is medically relevant to you? It’s determined by the data they’ve been collecting over the years. Your individual differences are not their priority. Does that sound counter-intuitive? I thought so, too. Over the years, we started to think that we could depend on insurance companies to provide for our wellbeing. The truth is that this may be one of the biggest mistakes we are making: giving away ownership and control over our bodies and our health.
I believe that no one should suffer because they cannot afford the critical treatments or medications that can save a life. For that reason, universal healthcare is important. But, just like you don’t expect your car insurance to pay for the maintenance or upgrade of your car, you shouldn't expect health insurance to cover anything you want to upgrade your quality of health or life. When it comes to crisis, having an insurance can help so that you won't go bankrupt to save your life.
However, taking your health to the next level, so that you can actually thrive and enjoy your life, instead of just surviving day by day, it has to come from YOU and only depends on your commitment and effort you put in for yourself. And that is what will decide your true health, wellness and the future you want to create for yourself.
So how are you feeling today? How is your health affecting your daily life? And what are you doing for it? Is it enough for you? If not, what will you do?