An Update on Insurance Changes and What They Mean for Your Care at AndyND

A Behind the Scenes Update on Insurance and Your Care

In my last update, I shared a behind the scenes look at one of the most challenging parts of practicing medicine: navigating the insurance system.

Since then, a lot has changed.

Some of these changes improve access in meaningful ways, while others introduce new barriers for both patients and small clinics trying to provide thoughtful, sustainable care. I want to walk you through what is new, what is staying the same, and what all of this means for your care moving forward.

Where Things Stand Now With Insurance

One of the most meaningful updates is that I am now fully credentialed with Regence BlueCross BlueShield. This means I can bill Regence directly under my name, and visits are continuing as expected at this time, including both office visits and manual therapy services.

I am also now credentialed with Oregon Health Plan under the Open Card Fee For Service, while remaining out of network for CareOregon and other CCO plans. I will continue to try to become an in-network provider with CareOregon, however they have been closed to new providers for many years.

In addition, I continue to work with Kaiser Permanente through the Heraya network, and those visits remain unchanged for now.

On the surface, this represents progress in expanding access. And in many ways, it is. At the same time, the reality underneath these contracts is becoming more complex.

The OHP Shift That Changes Access to Manual Therapy

One of the most significant recent changes has come from Oregon Health Plan. OHP is now requiring prior authorization for osteopathic manipulative treatment and other manual therapy codes. These are the codes I commonly use for manual therapy in my practice including pelvic floor therapy, abdominal and uterine massage, pregnancy massage, and others.

In theory, prior authorizations are designed to ensure appropriate care. In practice, they often create barriers that delay or prevent patients from receiving the treatments they need. The challenge in my situation is that, as an out of network provider, at this time it appears I do not have access to submit prior authorizations. This effectively means that these services are not covered, even when they are clinically appropriate.

Manual therapy is not an add on in my practice. It is a core part of how I support patients with pain, injury recovery, nervous system regulation, and pelvic floor dysfunction. Losing coverage for these services creates a real limitation in how care can be accessed through OHP.

Providence and the Breakdown of Coverage for Naturopathic Care

Another major shift has occurred with Providence Health Plan (now managed by American Specialty Health Networks). They are now requiring prior authorizations for naturopathic visits, and so far, even when prior authorizations are submitted, I have not seen ANY reimbursement for those visits.

Understandably, this is unsustainable. Because of this, I will be de-credentialing with Providence at the end of my current contract. This goes for all ASH Networks, which include plans like Cigna and Aetna as well.

This decision was not made lightly. It reflects the reality of trying to provide thoughtful care within a system that is not reliably supporting that care.

Pacific Source and MODA

As a reminder, I was told by representatives at Pacific Source and MODA that, despite the ongoing primary care shortage, they are currently closed to credentialing new providers.

The Reality of Practicing Without Pay Parity

These changes highlight a broader issue that continues to shape naturopathic medicine in Oregon.

Although naturopathic physicians are licensed as primary care providers, we do not have pay parity. Insurance companies reimburse us at lower rates than other providers for the exact same billing codes  (approximately 1/3 the amount paid to other providers billing the exact same codes!), while still requiring that we bill for all services rendered. This means I am legally obligated to bill manual therapy codes if I do manual therapy in a visit (this includes pelvic floor therapy, abdominal and uterine massage, pregnancy massage, etc. ).

At the same time, much of the work that goes into patient care happens outside of the visit itself. I am reviewing labs, coordinating care with specialists, managing referrals, and following up to make sure treatment plans are progressing in a meaningful way. This is essential work, but it is not covered by the amount your insurance pays for an office visit.

Because of that, appropriate reimbursement for the services that are billable becomes critical. It is what allows me to keep the clinic running, support my staff, and continue offering comprehensive, relationship-centered care in a sustainable way.

When I wrote my last blog, I spoke about the disconnect between the cost of insurance and the reality of accessing care. That disconnect is still present, and in many ways it is becoming more visible.

Insurance companies continue to determine what care is covered, how it is accessed, and whether providers are reimbursed. At the same time, small clinics are working to provide thoughtful, individualized care within systems that do not always support that model.

These changes are not just about contracts. They are about whether this kind of care can continue to exist in the current insurance model.

What This Means for Your Visits

For patients with Regence or Kaiser affiliated plans, visits will continue as they are now. I will continue billing both office visit codes and manual therapy when appropriate.

If insurance companies begin to deny manual therapy services in the future, I may need to introduce a non covered service fee for bodywork and pelvic floor therapy. This would allow me to continue offering these treatments while maintaining the sustainability of the practice.

For patients with Oregon Health Plan Open Card, manual therapy services will likely not be covered and I am still in a decision process for how to handle this lack of income moving forward. Stay tuned, but know I will never make any adjustments to care including the cost of your care without first discussing with you.

For patients with Providence, Aetna, or Cigna, I will be leaving these networks by the end of 2026 and am happy to transition you to an equity-based out of pocket rate.

What You Can Do to Help Create Change

One of the most important things to understand in all of this is that your voice matters.

Insurance companies ultimately respond to their members. While providers can advocate and push for change, the reality is that patient feedback carries the most weight.

If you have been impacted by these changes, whether it is loss of coverage for manual therapy, difficulty accessing naturopathic care, or increasing barriers like prior authorizations, I encourage you to contact your insurance provider directly.nLet them know that you value access to this type of care. Let them know that these services matter to your health and your quality of life.

You are paying for your insurance. You deserve to have meaningful access to the care you need.

When enough patients speak up, it creates pressure for change in a way that providers alone cannot.

This system shifts when patients use their voices, and your voice truly does make a difference.

Continuing the Shift Toward a Sustainable Care Model

Because of these ongoing challenges, I continue to move toward a community supported direct care model.

This approach allows care to be structured around what patients actually need, rather than what insurance dictates. It creates transparency around cost, removes many of the barriers created by prior authorizations and denials, and allows for more time and connection in each visit.

It also supports the long term sustainability of the practice, so that I can continue offering this kind of care to the community.

My Commitment to You

Even as these systems shift, my commitment remains the same.

I am here to provide thoughtful, individualized care, to be transparent about how these changes affect you, and to continue advocating for access to naturopathic medicine.

I will continue accepting Oregon Health Plan for as long as I am able, even as these changes create new challenges within that system.

If you have questions about your specific insurance plan or what these updates mean for your care, I encourage you to reach out. These conversations matter, and I want you to feel supported in navigating them.