Rates and Insurance
We accept and bill many insurances. Some common insurance plans that we use are Providence, Regence Blue-Cross/Blueshield, Pacific Source commercial plans (not OHP), Aetna, Moda, and others. You can use the worksheet below to call your insurance company in order to understand your benefits. Co-pays are collected at the time of service and you will be responsible for paying any charges not paid for by your insurance including deductibles.
Unfortunately we are unable to bill Oregon Health Plan (OHP) at this time.
If you have any questions regarding billing or insurance, feel free to reach out directly to our billing department at: 971-273-9254
Medical Insurance Glossary
A list of common words and their definitions to assist in understanding medical insurance and the patient responsibility for services covered by insurance. Note: terminology may vary between insurance companies.
Allowed amount- The dollar amount insurance companies allow for each office visit or service as determined by their contract with Deep Roots. For example, the clinic may charge $300 for an office visit, but the amount allowed by the insurance plan may be $180.
Appeal- an official request made to an insurance company by the insured or a provider to dispute a denied or mishandled claim and ask for reconsideration.
Coinsurance- the percentage of the allowed amount that insurance assigns as the patient’s responsibility. Most plans will have separate in-network and out of network coinsurance rates. For example, if a patient has a 20% coinsurance and the allowed amount for an office visit is $180, the insurance plan will pay $144 and the patient will be responsible to pay $36 (20% of $180=$36)
Copay- a fixed rate assigned by the insurance plan that a patient will pay for each time services are rendered. Copays may differ depending on type of service and provider network status. For example: $5 copay for primary care visits; $40 copay for specialists.
Deductible- the amount determined by the patient’s insurance plan that the patient must pay annually towards their medical care before insurance will contribute. Most plans will have separate in-network and out of network deductibles. Some services may not be subject to the deductible. For example, if an insurance plan has a $1,000 deductible, the patient will have to pay the full allowed amount for each visit until they have reached $1,000 at which point insurance will start to pay.
Claim- a document submitted to insurance that includes patient details, procedure codes, diagnosis codes, and cost of services in order for insurance to pay Deep Roots on the patient's behalf.
Explanation of Benefits (EOB)- a document provided by insurance which outlines the details of how a claim was processed. The information found on an EOB includes the allowed amount, the amount paid by the insurance plan, and the amount assigned to the patient.
In-network providers- medical providers who have a contract with the insurance plan. Note: a provider may be contracted with an insurance company, but not in-network for every plan that company offers.
Out-of-network providers- medical providers who are not contracted with the medical plan. Note: a provider may be contracted with an insurance company, but out-of-network on some plans that company offers.
Out-of-pocket max- the maximum annual amount determined by the insurance plan that a patient will have to pay towards their medical care. This resets annually. The types of payments made by patients that go toward the out-of-pocket max are determined by your insurance company. For example, if the out-of-pocket max is $6,000, once the patient has paid $6,000 towards medical expenses, insurance will pay 100% of insurance covered medical expenses.
Plan- an insurance benefit package which details services covered, deductible, copays, co-insurance, and plan limitations.
Preauthorization- a process in which a provider seeks approval from an insurance plan to cover a specific treatment based on medical necessity. Not all insurance companies will accept preauthorizations from naturopathic doctors.
Primary Care Provider (PCP)/Medical Home- a medical provider recognized by an insurance plan to coordinate care for the patient as a medical home. Currently Deep Roots cannot be designated as a medical home and PCP.
Primary Care- health care services provided by a doctor, nurse practitioner, or physician assistant that cover a wide range of services such as preventative care, wellness, and treatment of common illnesses. Deep Roots can provide primary care services to our patients, however Deep Roots providers are not able to be designated as a PCP. Therefore some insurance companies will not cover certain services (such as sports physicals or well visits).
Provider- a certified or licensed healthcare professional such as a Naturopathic Doctor (ND) or a Family Nurse Practitioner (FNP)
Specialist- a provider who offers specialized services. Some insurance plans recognize NDs as specialists and therefore we are not able to bill primary care services such as wellness visits. Some insurance companies that require a PCP/Medical home designation may view nurse practitioners as out of network providers because they are not specialists. (Yes… even though the naturopathic providers at the same clinic are in-network specialists.)
Wellness visit- an office visit for an individual without any serious illness or symptoms. Most insurance plans offer one wellness visit annually at no cost to the patient.