Insurance Credentialing Update

I want to let you in on a bit of a behind the scenes secret about healthcare.

One of the most challenging parts of opening or running a medical practice is not diagnosing illness, creating treatment plans, or caring for patients. It is navigating the insurance system.

Most patients never see this side of medicine, but a tremendous amount of time, energy, and paperwork goes into working with insurance companies. Credentialing alone can take months, phone calls often go unanswered, and even when contracts are in place there is no guarantee that claims will actually be paid.

Because I value transparency and want patients to understand how these systems affect access to care, I want to share an update on my current insurance credentialing status and explain some of the larger challenges shaping the future of this practice.

This information reflects the status of contracts and applications as of March 8, 2026.

Insurance Plans I Currently Accept

At this time, I am able to see patients with the following insurance plans.

• Heraya Health

• American Specialty Health

• Providence Health Plan

• Regence Blue Cross Blue Shield

• Oregon Health Plan

• Aetna

Some of these plans are credentialed directly with my practice, while others are billed through a colleague while my credentialing is still in progress. Below is a breakdown of which plans are active, which are pending, and which contracts I have chosen not to continue.

Plans I Am Currently Credentialed With

At this time I am credentialed with the following networks.

• Heraya Health

• American Specialty Health Network

• Providence*

Patients with these plans are currently able to schedule visits and claims will be submitted under my name.

The Providence* Problem

Providence recently changed their system so that naturopathic care must now go through American Specialty Health Network. This change has introduced a new requirement that every visit must receive prior authorization.

Prior authorizations mean that insurance companies must approve the visit before it happens. In theory this process is meant to control costs and ensure appropriate care. In practice, it often creates significant administrative work without improving patient outcomes. It also represents uncompensated labor for medical clinics, requiring time to submit documentation, communicate with insurance companies, track approvals, and appeal denials. For solo practices in particular, this administrative burden can quickly become unsustainable.

At my previous clinic we found that even when prior authorizations were obtained, many of those claims were still rejected or left unpaid.

For now I will continue accepting Providence plans and monitor how claims are processed under the new system. If the pattern of denials continues, I may eventually need to discontinue that contract.

Plans I Can Bill Right Away Through a Colleague

While some of my personal credentialing applications are still pending, I do have the ability to bill certain plans through a colleague. This allows patients with the following insurance plans to be seen immediately.

• Regence Blue Cross Blue Shield

• Oregon Health Plan

• Aetna

This arrangement helps bridge the gap while my direct credentialing continues moving through the system.

Insurance Applications That Are Still Pending

Several insurance contracts are still in progress.

Oregon Health Plan

The Oregon Health Plan is currently about three months behind in reviewing applications. After review, there is an additional 60 to 90 day approval period before credentialing becomes active.

This means the timeline for approval can stretch well beyond several months.

Regency Blue Cross Blue Shield

The Regency credentialing process is currently underway, although their systems are not particularly straightforward. I am actively working through the process to determine the final pathway for direct credentialing.

Insurance Networks That Are Closed to New Providers

Despite the ongoing shortage of primary care providers, some insurance networks are currently closed to new clinicians.

PacificSource

PacificSource is currently closed to new provider applications, even in cases where a physician is simply moving their practice location rather than joining the network for the first time. Because of this, I cannot transfer my credentialing from my previous clinic.

Moda

Moda has not returned phone calls or emails regarding transferring my credentialing from my previous location to this new practice. I will continue attempting to reach them, but at this point there has been no progress.

Insurance Contracts I Have Chosen to Discontinue

Running a small clinic requires careful attention to whether insurance reimbursement actually supports the time and care that goes into each patient visit.

After reviewing payment data from the past year, I have made the decision to discontinue several insurance contracts.

United Healthcare

Over the past year, United Healthcare paid only about 20 percent of submitted claims. Some of the approved payments were as low as twenty five dollars for a visit.

That level of reimbursement simply does not support the time required to provide thoughtful, comprehensive care. For that reason, I have decided to discontinue my United Healthcare contract.

Cigna

After reviewing the past year of claims, Cigna paid only about 50 percent of submitted claims. Even when services were covered benefits, many claims were denied or left unpaid.

Because of these low payment rates and frequent denials, I have decided not to move forward with a Cigna contract.

First Choice Health

I am also discontinuing First Choice Health due to consistently low reimbursement rates.

The Larger Challenge: Insurance, Pay Equity, and the Cost of Care

These experiences reflect a broader issue in healthcare that many patients rarely see from the inside.

In Oregon, naturopathic physicians do not have true pay equity with other primary care providers. Even when naturopathic doctors provide the same services, insurance companies reimburse those services at lower rates or apply additional restrictions.

But the challenge is not only about reimbursement rates. It is also about the larger structure of a healthcare system that prioritizes bureaucracy and profit over relationships and care.

Insurance companies ultimately determine what services are covered, how much patients pay, and whether providers are reimbursed at all. Many essential parts of patient care such as care coordination, reviewing complex labs, communicating with patients between visits, and extended counseling are not reimbursed services.

Administrative requirements such as prior authorizations add even more unpaid work to already busy clinics. These processes consume time and energy that could otherwise be spent caring for patients.

At the same time, many patients are paying monthly insurance premiums that are significantly higher than the cost of the care they receive in my clinic. It is not uncommon for someone’s monthly premium to exceed the cost of the services they use here.

That disconnect raises an important question. If patients are paying so much into the system, why does it still feel so difficult to access care?

These structural issues make it difficult for small independent clinics to survive within traditional insurance models while also delivering the kind of thoughtful, relationship centered care that patients deserve.

Why I Am Moving Toward a Community Supported Direct Care Model

Because of these challenges, I am gradually transitioning toward a community supported direct care model.

This shift is rooted in a simple idea that guides how I want to practice medicine: People over profit.

Direct care removes many of the barriers created by insurance companies. Instead of insurance dictating how visits are structured, how much time can be spent with patients, or which treatments are allowed, care can be built around what patients actually need.

It also allows for something that is increasingly rare in healthcare: transparency.

Patients know exactly what they are paying for and what they are receiving. There are no surprise bills months later, no unexpected claim denials, and no confusing explanations of benefits that do not reflect the reality of a visit.

This model also allows me to grow the clinic in a sustainable way. My goal is to build a practice that can support a small team, pay staff fairly for their work, and ensure that the people caring for patients are valued for the care they provide.

Most importantly, it allows me to practice the kind of medicine that brought me to naturopathic care in the first place.

• Listening carefully

• Spending meaningful time with patients

• Addressing root causes of illness

• Supporting long term health rather than rushing through short visits

A community supported model creates stability for the practice while keeping the focus where it belongs: on patient relationships and meaningful care.

My Commitment to Patients

My goal has always been to build a clinic that offers accessible, thoughtful, and sustainable care for our community.

Insurance will still remain part of the practice where it makes sense and where it allows patients to access care. I will continue navigating credentialing processes when possible, even when those systems move slowly.

One commitment that will not change is my dedication to serving patients with Oregon Health Plan. I will continue accepting OHP for as long as Medicaid will have me. Expanding access to care for patients who rely on OHP is incredibly important to me, and that conversation deserves a deeper discussion in a future blog post.

As the clinic grows and the care model evolves, my focus remains the same.

• Transparency

• Fairness

• Access

• People over profit

If you have questions about your insurance, about the direct care model, or about what this transition means for you as a patient, please reach out. I am always happy to help you understand your options.