Insurance & Admin fee at Rebel Med NW's
Integrative Concierge Clinic

Admin Fee

Our Admin fee or Facility fee charged each insurance based visit goes towards the the extra time our providers spend during care visits to support your medical care, 2 week post visit time for answering any questions or support of a previously discussed care concerns. Additionally our concierge practice supports direct cost of billing insurance, merchant processing fees, and administrative costs associated with billing your insurance plan. While this may be new, it does allow us to stay in-network with some of the insurances that still provide adequate reimbursement for the services we provide for disease evaluation while still aiding our ability to support health optimization. It has become increasingly more difficult and administratively time consuming to fight denials, generate prior authorizations for medications, imaging, or services. This fee is in addition to any patient responsibility for services or care. This fee is absorbed into the final cost of a visit if insurance denies benefits for any service or determines that a service is not medically necessary per their benefit plan. We will adjust the visit to our direct pricing rate for all patients equally.

Naturopathic Insurance based care:

An Admin fee of $25 per 30 minute appointment is charged. Initial visits, prolonged visits and annual exams are $50 when a visit is over 30 minutes. This also allows us to take additional time before, during and after your visit to support your care.

Acupuncture Insurance based care:

An Admin fee of $25 is charged per visit, and and additional $25 is charged for EAMP services, this includes manual therapy/cupping/bodywork, therapeutic education, dietary education, breathwork and is not covered by insurance.

Insurance companies and plans vary widely and change with little notice. We encourage our patients to call their insurance providers for detailed coverage benefits at our office.

Not all services at our office are deemed “medically necessary” in the eyes of insurance companies. We are considered “in-network” with insurance to augment care and accessibility to our medicine, but the level of patient responsibility (copay/coinsurance/deductible) per services will vary.

If you do not see your insurance provider listed below then they are considered “Out-Of-Network”. The patient will pay our self-pay pricing at the time of service and we can provide a detailed superbill that you can submit to your insurance for out of network reimbursement. For example, the First Choice Network has been closed to acupuncturists for several years, but they offer out-of-network reimbursement.

List of Insurances our Naturopathic Doctors are In-Network with

Naturopathic providers are considered in network with the following insurances, however your individual plan may exclude Naturopathic coverage:

- LNI (Labor & Industry work injury) – Drs. Simon
- Blue Cross Blue Shield (BCBS) – Naturopathic coverage varies by state, please call to confirm. – All ND Providers
- Regence Blue Shield / Uniform/ – Naturopathic coverage varies by state, please call to confirm. – All ND Providers
- Premera Blue Cross / Anthem – Naturopathic coverage varies by state, please call to confirm. – All ND Providers
- First Choice / First Health Network/ Kaiser PPO (will have First Choice/First Health on the insurance card) – All ND Providers
- Molina Apple Health/Medicaid (Closing Jan 2024)
  - Drs. FauntLeRoy, Hernandez
  - Dr. Simon only accepting New Molina Apple Health patients seeking Biofeedback therapy until end of 2023.
- Molina Marketplace
- Aetna – Dr. Simon (removal Jan 2024)
  - Other ND Providers out of network (Severson, FauntLeRoy, Hernandez)
- Kaiser PPO (not associated with First Choice) – Dr. Simon
- Coordinated Care (Ambetter exchange plan, not Apple Health)- Dr. Simon
- Cigna/ASHLink – All providers
- Motor Vehicle Accident(MVA) /Personal Injury Protection(PIP) – All providers

List of Insurances our Acupuncture Providers are In-Network with

Acupuncture providers will be in network with the following insurances:

- No LNI offered at this time.
- Regence Blue Shield / Uniform / RGA – Acupuncture coverage varies by state, please call to confirm.
- Premera Blue Cross / Anthem – Acupuncture coverage varies by state, please call to confirm.
- Blue Cross Blue Shield (BCBS) – Acupuncture coverage varies by state, please call to confirm
- Aetna – Khai & Phonexay
- Cigna/ASHlink – Khai & Phonexay (removal Jan 2024)
- Kaiser PPO – Phonexay
- Coordinated Care – Phonexay
- MVA/PIP – Khai and Phonexay
- Please also account for the $25-75 non-covered services that are provided during our acupuncture visits.

COURTESY OF REBEL MED NW

The worksheet below is a guideline and tool for your use to understand your insurance benefits. It is a comprehensive document for you to learn from your insurance provider about your specific plan and how it may be applied at our office. You can use as much or as little of it as you would like.

Some ways to complete this worksheet:

ONLINE: Log into your personal account for your Individual Insurance Plan. You should be able to find much the information you need within that database.
DOCUMENTS: Some plans come with a Benefits Package Document that lists your Insurance Benefits, you may also use that document to complete this worksheet. This document may have been given to you when you signed up for your insurance plan, or you may need to log into your personal plan account (see item 1).
CALL: Whatever information you find missing after that, you can choose to contact your insurance representative directly.

COURTESY OF REBEL MED NW

This worksheet is a guideline and tool for your use to understand your insurance benefits. It is a comprehensive document for you to learn from your insurance provider about your specific plan and how it may be applied at our office. You can use as much or as little of it as you would like.