We offer our patients comprehensive care which limits the ability to work within the limitations of most contractual agreements for health insurance. Payment is required at the time of service. NIHA does not accept assignment or file or coordinate insurance reimbursements although we may provide information on the services rendered for you to submit.
You are responsible for filing your own claim and following up as needed. Please be advised, however, that many of the services provided are not covered by most insurance companies. Please contact your insurance company for information on your coverage. We are not providers for HMO insurance, Medicare, or Medicaid.
The information below should assist you with filing for insurance reimbursement.
Policies Regarding Insurance for Certain NIHA Practitioners:
For Dr.Rind and Dr. Wilson:
For services provided by the above listed practitioners, services should be considered on a cash basis and insurance support services will not be provided. A bill describing services will be provided, but will only use procedural billing codes at the discretion of the practitioner. You may complete your insurance company's claim form and submit a request for coverage, but NIHA will not provide a claim form (HCFA 1500), nor will it respond to requests for additional information. Patients may request a copy of their records and personally respond to requests by their insurer for additional information.
For Dr.Beals, Dr. Solomon, and Dr. Kannankeril and All Other NIHA Practitioners:
For services provided by the above listed practitioners, NIHA will provide claim forms for submission to insurance; submission shall be the patient's responsibility. Claim submissions may or may not be for covered services and may or may not include procedural codes or other data sufficient to support the insurer's determination as to what services it will reimburse. NIHA may provide records requested by the insurance company. If possible, NIHA will advise whether the insurance will cover any particular expenses, but given the uncertainty that pervades insurance decisions, cannot be responsible for any information that turns out to be incorrect.
For Dental Practitioners:
Patients will receive an ADA (dental claim form), that will include all necessary information that is needed to file for reimbursement, along with a receipt for the services rendered.
Additional Information:
Filing for Reimbursement
Methods for filing vary by company, but generally you will need to mail the bill provided at check-out (we suggest keeping a copy for yourself) to the address or post office box provided by the insurer or your employer. All of our practitioners have opted-out of Medicare. For secondary payers to Medicare, we will provide a copy of the practitioner’s opt-out affidavit.
Insurance Requests
If we get requests for additional information, we will forward the request to you along with copies of the requested notes, x-rays, etc. for submission to the insurer. If your insurer requires their form be filled out and submitted, you will need to fill it out and in the section where your practitioner’s signature or specific information is needed write, “see attachment.” Then attach the claim form, notes, x-rays, etc. we provided you and mail them to the insurer. As always, we urge you to make a copy of the information before submitting.
Not Recognized Care
Some of the care provided may not be recognized by your insurance company. Often these claim forms will be returned to you or us with a message like, “in order to process your claim we must have a correct CPT code” or “CPT code not valid”. Some of the services we provide do not have CPT codes, as the codes are set by the conventional medical community. Insurers rarely pay for services without a CPT code. We can provide you with a brief description of these services that you can submit for claim review, in the event you still wish to pursue payment.
Reimbursement Problems
Securing payments for insurance companies can be difficult, whether the services rendered were conventional or alternative. Your best bet is to keep close track of what and when you submit to your insurer and challenge or appeal any decision they make which is not explained to your satisfaction. If you are still dissatisfied and believe the insurer has not properly reimbursed you, you have two other options that are occasionally effective:
1. Contact your employer and ask them to intervene on your behalf. They often have more clout with the insurer, since they hire the insurer and pay the bill.
2. Contact your state’s insurance department. They will typically take your complaint directly back to your insurer, asking them to explain why (based on the contract) that something was not covered.
Insurance Billing Services
There are individuals and companies which, for a fee, can assist you with claims filing and reimbursement from insurance or flexible spending account administrators. A list of firms offering these services is available upon request.
