Leverage your Health Insurance
(and Explore Insurance Alternatives)
Figuring out how to leverage your health insurance to pay for doctor visits, labs and prescriptions for actual health care (vs. disease care) is a common frustration for many of us as we navigate our health journeys.
To heal, we need to navigate the system differently. The talk with Gretchen Bronson on Health Insurance is excellent, and here is a short list of strategies for leveraging your health insurance to get your health costs covered.
Getting Your Functional Medicine Doctor Covered. Many people can use their insurance to at least have their functional medicine doctor visits partially covered as out-of-network PCP visits.
What this looks like is, you’ll pay the provider for the visit up front and your health insurance will reimburse you whatever your benefit is for the visit. Call your insurance company to find out what this amount is, any requirements for coverage, and to confirm the process for submitting for reimbursement.
Using Insurance to Cover Labwork. If you want to use your insurance to cover labwork, determine what labs you want run (here is the optimizing labs tracker) and bring those to your doctor at your appointment along with the CPT codes (also in the lab tracker).
Many times, the resistance doctors have to running “all those labs” is they don’t have the staff to look everything up and make the requests.
To confirm coverage, call your insurance company, tell them what labs you want run and ask them what the criteria is for coverage. Oftentimes, they’ll want specific ICD-10 codes to be part of the order so it will be covered. You can then pass this on to your doctor so they submit the information properly on your behalf.
Order Your Blood (Serum) Labs Direct from Ulta Labs! If you need to pay for labs as an out-of-pocket expense to go against your deductible (or if you don’t have insurance), Ulta labs is a direct-to-consumer lab provider that white-labels Quest Labs.
Their prices are often cheaper than what you can get through your health insurance (especially if you have a high-deductible plan). If you’re wanting to save money here, call around and compare prices. See what LabCorp or Quest will charge you with your insurance, and then compare to a Direct-to-Consumer company like Ulta Labs.
If you use a company like Ulta Labs, you’ll want to submit your receipt to your insurance company so the cost will be applied to your deductible.
Redirect Health – Redirect Health is a new kind of healthcare provider … not insurance. They cover 100% of primary care doctor visits, annual well woman exam + mammogram, some labwork from LabCorp, and unlimited chiropractic visits.
They can help you significantly reduce your doctor bills in case of hospitalization, too. Their core plan is $125 / mo per person, and you must have a business with at least 2 employees to sign up.
Samaritan Ministries. I don’t personally have experience with them, but my friend Katie Wells over at WellnessMama.com has a great write-up on them.
KNEW Health. My friend James Maskell is launching a health share program similar to Samaritan Ministries that’s getting a ton of buzz in the functional medicine / ancestral health space.
As part of the program, every customer gets a free health coach. As I understand it, you’ve got more upfront costs to get diagnosed, and then after diagnosis, they cover all treatments (even alternative ones).
Good Rx Card. Everyone should have the Good Rx card on hand for prescriptions! It is often cheaper to use the Good Rx card for your prescriptions than your insurance benefit. You simply enter your prescription into the app and it will tell you cost across a variety of dispensaries in your area so you know where it’s cheapest. I love the Good Rx card app!