The Top 9 Mistakes Integrative and Lifestyle Medicine Doctors Make When Dealing With Medical Insurance | Integrative Practice Builder

As an integrative medicine doctor, you know patients always want to use medical insurance. If you currently submit to insurance payers, you know that making mistakes can lead to denied claims and lost money. If you're a cash-only practitioner, you know that patients request superbills for services rendered.

While most doctors are pretty careful with this, even the most careful doctors can make mistakes when it comes to dealing with their patients' medical insurances.

Here are the top nine mistakes integrative medicine doctors make when dealing with medical insurance. Avoid these errors and you'll be able to better utilize your patients' health insurance benefits!

Mistake # 1 Not billing insurance for services rendered.

Most doctors only know evaluation and managment (E&M) codes since it describes the visit type. However, did you know there are now digital communication CPT codes that are reimbursed? Furthermore, many integrative health practices are not billing for things they are already doing, such as assessing for behavioral change for chronic disease. This can be a costly mistake, as you may not receive payment for services rendered if the patient does not submit a claim to their insurance company.

Mistake # 2 Not verifying patient eligibility and benefits prior to providing care.

You need to know what services are covered by the patient's insurance plan in order to provide an accurate estimate of out-of-pocket costs. If you provide care without knowing these details, you may end up spending more time and money than necessary on chasing down unpaid bills. Worse off, integrative, functional and lifestyle medicine doctors are already dealing with a complex population of patients who will be more ticked off if they don't know how much they're paying out of pocket BEFORE a service is rendered.

Mistake # 3 Not keeping track of patient co-pays and deductibles. .

Co-pays and deductibles can add up quickly, so it's important to keep track of how much the patient owes. This will help you avoid billing the patient for amounts they have already paid, and ensure that you are being reimbursed accurately by the insurance company. Remember, integrative medicine is all about communication. While talking about co-pays and deductibles may not be part of a doctors usual discussion, uncertainties in financials create a massive amount of distrust between a patient and his/her clinical provider. 

Mistake # 4 Not submitting claims in a timely manner.

Insurance companies typically require claims to be submitted within a certain timeframe (usually 30-60 days). Failing to submit claims on time can result in loss of reimbursement from the insurance company. Most of the time, the claim delays are due to the doctor not finishing, closing, or locking their notes in the EMR. If the practice use paper submission, that's worse since physical paper can get lost or damanged.

Mistake # 5 Not keeping up with ever-changing insurance policies for reimbursement and procedures.

The rules and regulations surrounding medical insurance can change frequently, so it's important to stay up-to-date on these changes. If you're not familiar with the latest policies and procedures, you may not be able to bill insurance companies correctly, which could lead to lost revenue. However, this is NOT easy since there is not really one place to find the information. The best thing to do is to look at your claim denials regularly and uncover patterns. Learn from these patterns and it will lead you to change in reimbursement.

Mistake # 6 Not optimizing the workflow of the electronic health record (EHR) system.

An EHR system can help automate the billing process and make it easier to submit claims accurately and on time. If you're still using a paper-based filing system, now is the time to make the switch to electronic records. However, when it comes to integrative health, there will need to be customizations. For example, supplements the patient takes, their diet, lifestyle, all need to be documented on every visit since these change. Furthermore, if the EHT allows the patient to live-adjust the info, it will take a tremendous amount of pressure off of the staff.

Mistake # 7 Not offering a payment plan to patients.

A payment plan can help patients spread out their payments over time, making it more affordable for them. This can also help reduce the amount of unpaid bills you may have in your practice.

Mistake #8 Not having a clear billing policy in place.

Having a clear billing policy in place can help avoid confusion and ensure that patients understand what they are responsible for payment. A billing policy should include information on co-pays, deductibles, payment plans, and insurance coverage.

Mistake #9 NOT accepting medical insurance or NOT providing a superbill for patients.

While this may seem like a way to avoid dealing with insurance companies, it can actually have negative consequences down the road. If you're a cash-only integrative health practitioner, and you do not provide patients superbills for services rendered, you will likely get an earful from patients who have great insurance coverage. Furthermore, if patients are being reimbursed by their insurances for your services, then they will want to come back. Understanding and knowing the existance of CPT codes that correlate with what you do is immensely important and your patients will think you're a rockstar for trying! Competition in the integrative health space of practices that do take in-network insurances is non-existant at this point!

If you're a integrative, lifestyle, or functional medicine doctor who wants to or who takes medical insurance, I have created a learning platform just for you! Head to Integrative Practice Builder to learn more!

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Cheng Ruan, MD

CEO Texas Center for Lifesyle Medicine.

Creator of the Integrative Practice Builder