A Naturopathic Doctor (ND) is a healthcare provider who emphasizes prevention and wellness, utilizing natural therapies alongside conventional diagnostic tools. NDs graduate from accredited, four-year medical programs, studying basic sciences, clinical nutrition, and botanical medicine. Whether an ND’s services are covered by insurance is highly variable, depending on state laws, insurance carrier policies, and the specific services provided. This complexity means coverage is not universal across the United States, making the answer rarely a simple “yes” or “no.”
The General Landscape of Naturopathic Insurance Coverage
Coverage for services provided by Naturopathic Doctors is less common than for services from Medical Doctors (MDs) or Doctors of Osteopathic Medicine (DOs). This inconsistency exists because NDs are not universally recognized as eligible providers by all major national insurance carriers or government programs. For instance, Medicare does not currently recognize NDs as eligible physicians, limiting coverage options for many patients.
When coverage is available, it distinguishes between “in-network” and “out-of-network” provider status. It is rare for an ND to be fully “in-network” with large national plans. Licensed NDs are more commonly considered “out-of-network” providers, requiring the patient to pay the full fee upfront and then seek partial reimbursement from their carrier.
In out-of-network scenarios, the insurance company processes the claim based on whether the specific services, identified by Current Procedural Terminology (CPT) codes, are covered when performed by any licensed provider. Even if covered, the patient’s out-of-pocket costs are subject to the plan’s deductible, copay, and coinsurance requirements, often at a higher rate than for in-network care.
State Licensing and Legal Mandates
Insurance coverage availability is linked to the legal recognition and scope of practice of NDs in a given state. Currently, 26 jurisdictions license or register NDs, but their practice authority varies widely. Only NDs who are fully licensed and regulated within a state’s scope of practice can legally bill insurance for their services.
In states where NDs are licensed and recognized as primary care providers (about a dozen states), insurance acceptance tends to be better. This recognition allows them to bill for services using the same CPT and ICD-10 codes used by other physicians, such as for office visits or diagnostic lab work. However, licensing does not automatically mandate coverage, as some states with licensure do not require insurance companies to include NDs in their networks.
Federal and state regulations, such as Section 2706 of the Affordable Care Act and “provider non-discrimination laws,” attempt to prevent insurance plans from excluding providers based solely on their license type. These mandates aim to establish inclusion for NDs, but enforcement and interpretation are inconsistent across different plans and states. Coverage is nearly impossible in jurisdictions where NDs are unlicensed and operate purely as health consultants, as they cannot legally diagnose, treat diseases, or bill for medical services.
Practical Steps for Verifying Coverage and Payment Options
Patients should contact their insurance carrier directly to verify coverage before scheduling an appointment, as the ND’s office staff may not have specific policy details. When speaking with the insurer, patients should ask whether the policy covers services performed by a licensed ND and clarify the distinction between in-network and out-of-network benefits. It is also helpful to ask about coverage for common CPT codes for office visits, such as 99385 for a preventative medicine visit.
Even if the ND’s visit is covered, coverage limitations for specific naturopathic treatments are common. Routine office visits and standard laboratory tests are often covered. However, treatments and products like nutritional supplements, herbal remedies, and specialized therapies such as intravenous (IV) treatment are usually excluded by insurance, often considered investigational or non-covered goods.
For non-covered services or patients with high-deductible plans, Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) offer tax-advantaged payment options. HSA and FSA funds can typically be used for consultation fees and lab tests ordered by a licensed ND. Nutritional supplements may qualify as eligible expenses if a Letter of Medical Necessity (LMN) is obtained from the ND. Many ND clinics also offer self-pay discounts and payment plans.