Insurance Coverage

Insurance Verification Worksheet for New Patients

New patients with commercial insurance plans (Moda, BCBS - not OHP) will be asked to complete an Insurance Verification Worksheet as part of the new patient paperwork.

The purpose of the worksheet is to help you gather information about your insurance coverage for visits with me (Dr. Heidi Wilson) while making the process of calling your insurance company easier to navigate.

The worksheet will be sent as a Questionnaire through the Charm patient portal. All the necessary instructions are included on the form itself. However, I’m including instructions here as well, for those who may prefer to view the instructions in one tab while the fillable Questionnaire is open in another tab.

Why completing the form matters:
- Helps you understand your coverage and likely costs
- Helps your provider submit claims correctly
- Helps confirm whether your plan covers naturopathic care and telehealth visits
- May help you understand your insurance benefits for other providers or services too.

Instructions for Completing the Worksheet:

Step-by-Step Guidance

• The worksheet is designed to walk you through the whole process step by step to reduce the cognitive and emotional effort these types of phone calls can take.

• The “Before You Call” steps can help you prepare so the call itself goes more smoothly.

Collapsible Sections

• Most sections of the worksheet are collapsible when completed within Charm as a questionnaire. (See screenshot of sections below.)

• You can expand sections as you need them and hide sections you’re not using. If forms tend to feel overwhelming, this can help reduce visual clutter and make the form feel more manageable.

• [Note: Collapsing a section will not erase your responses.]

Before You Call:

• Gather your insurance card(s).

• If available, log in to your insurance app or member portal, as it may contain information that isn't on your insurance card.

• If possible, use a computer instead of your phone to complete the worksheet in Charm. That way, you can easily fill out the worksheet while you're on the phone with the insurance company. If you don’t have access to a computer or a second device, let me know and we'll figure out an alternative.

Sections to complete before calling:

These sections can be completed using information from your insurance card or insurance member portal/app.

• Section 1: Patient Info & Call Setup

  • Includes the phone number you’ll be calling, which should be on the back of your insurance card (often “Customer Service” or “Member Services”).

• Section 2: Insurance Plan Details - insurance plan name, ID number, group number, plan type, etc.

• Section 3: General Medical Benefits - You may be able to fill in some of this section using your insurance card or portal, but plan to confirm it with the insurance rep so you can correct it if needed.

  • This section is about your general medical benefits, NOT naturopathic medicine-specific coverage.

  • e.g. deductible info, out of pocket max, primary care vs specialist costs, both in-network and OON.

• Section 6: Secondary Insurance - This section asks if you have more than one insurance plan and requires that you select “yes” or “no.”

  • When you have more than one health insurance plan, one is your primary insurance and the other is your secondary insurance. Both insurers need to know about each other so claims can be processed correctly, and to help prevent delays, denials, and unexpected bills.

  • If you have a secondary insurance plan, fill out this section before you call.

Other Preparation Tips: 

• Skim the form in its entirety to get oriented to the form and what you’ll be asking about.

• Set an intention for the call: to allow yourself to pause, ask questions, or request clarification as needed. (You're not expected to be an insurance expert.)

During the Call:

General Tips:

• Use the worksheet to guide the conversation and record the rep’s answers in the fields provided.

• If a question or field doesn’t apply to you or your plan, write “N/A” rather than leaving it blank, when possible.

• Include “$” or “%” when entering copay or coinsurance amounts.

• Fields marked with a red asterisk (*) are required.

Sections to Complete or Review During the Call:

• Section 3: General Medical Benefits- Verify your general medical benefits

  • e.g. deductible info, out of pocket max, primary care vs specialist visit costs, both in-network and OON.

  • Also confirm your annual reset date, i.e. when your deductibles and out-of-pockets maximums reset each year.

• Section 4: Naturopathic Physician (ND) Visits - Ask if your specific insurance plan covers office visits with NDs.

  • If ND visits are covered, you’ll skip ahead to Section 4a or 4b, based on my current network status with your insurance plan.

    • To confirm if I am in-network with your specific insurance plan, you can provide the insurance rep with the NPI(s) below:

      • Dr. Heidi Wilson - Individual/Rendering (Type 1) NPI: 1730430612.

      • If needed: Organization/ Billing (Type 2) NPI for Curio Integrative Mental Health LLC: 1295691244.

  • If ND visits are NOT covered or the insurance rep is unsure, please fill out the remaining questions in Section 4 and then skip ahead to Section 5.

    • If the representative says ND visits aren't covered, ask them to look up Dr. Wilson using her NPI number(s) (listed above). This can help if they're unfamiliar with naturopathic physicians (NDs) or aren't sure how to check your plan's coverage for ND visits.

  • In Section 4a and/or 4b, you’ll ask the rep about the copay ($) or coinsurance (%) amount per ND visit, if you need to meet your deductible before they’ll pay anything, visit limits, prior authorization, and if telehealth visits are covered.

    • Section 4a: In-Network ND Coverage - Complete this section if I am in-network with your insurance plan

    • Section 4b: Out-Of-Network ND Coverage - Complete this section if I am NOT in network with your insurance plan.

    • You only need to complete the section that matches Dr. Wilson's current network status. However, if you'd like both in-network and OON coverage information for future reference, you're welcome to complete both sections, but this is optional.

    • Don’t forget to ask about telehealth visit coverage, including if there are any limitations.

  • Note: If the insurance rep says ND office visits are covered the same way as Specialist office visits, you may be able to use the information from Section 3 for some of the ND coverage details in Sections 4a or 4b. However, it's still a good idea to double-check each item with the insurance rep.

• Section 5: Labs & Imaging- Ask if labs and imaging are covered when ordered by an ND and which lab/imaging centers are considered in-network.

  • Labs and imaging are billed separately from office visits. Coverage and cost often depend on where the test is done (the lab facility, e.g. Quest, Labcorp) and what test is ordered.

  • Insurance reps may not be able to give precise cost estimates, as out-of-pocket costs can vary significantly by test, diagnosis, and facility, and are commonly subject to deductible and/or coinsurance.

• Section 6: Secondary Insurance- If you have more than one insurance plan, confirm that your insurance company has your secondary insurance on file for Coordination of Benefits (COB). In the worksheet, scroll down to STEP 2 within Section 6 for questions to ask.

  • Insurance companies use a process called Coordination of Benefits (COB) to decide which plan pays first and how much each pays. Both insurers need to know about each other so claims can be processed correctly, and to help prevent delays, denials, and unexpected bills.

  • If they don’t have your secondary insurance on file, give them that plan information (which you’ll hopefully already have recorded in that section).

  • If they need you to complete a COB form or require anything else, be sure to write down what they need or any next steps. There is space on the worksheet for such notes.

• Section 7: Insurance Rep Info (optional) - record the insurance representative’s name and the call/reference ID.

  • Writing down the rep’s name and call/reference ID can be helpful if you need to follow up later or if there’s any confusion about what you were told.

NOTE: Because you're completing the worksheet/form as a questionnaire in Charm, it doesn't automatically save your progress.

- Don't close the questionnaire before clicking "Submit," or your responses will be lost.
- Don't click "Submit" until you've finished the worksheet and reviewed your responses. Once submitted, you won't be able to make changes.

After submitting the form, you will be able to view or download it at any time in your Charm portal, under Questionnaires or Patient Documents.