At Novomed Centers, we chose to work closely with insurance providers. By doing so, we can align our priorities with yours: returning you to optimal health with minimum out of pocket expenses.
However, certain services are not covered by insurance, such as allergy tests that can identify what you are allergic to before starting on a desensitization program to eliminate the allergy instead of resorting to prescribed medication.
Most insurance companies do not cover bariatric or obesity procedures that can reverse diabetes and high blood pressure once and for all.
An increasing number of patients are looking for an alternative to the fragmented care model by visiting our naturopathic or integrative medicine doctors that do not rush to prescribe a pill for every ill. Again, their services are not covered by insurance, although we try whenever possible to have our GP order some of the lab tests that are covered by insurance whenever possible.
Many expensive tests like CT scans, MRI’s and mammograms and all elective surgeries require pre-approval by the insurance company. Our efficient team does a good job at communicating with your insurance company. Our track record of quality, honest dealings, including the avoidance of unnecessary tests or surgeries, are recognized by insurance companies, which facilitates speedier approvals.
If your insurance policy has out-of-network benefits, a portion of our charges may be covered. Before your first visit, talk to your insurance company or to our patient support team about your out-of-network benefits and what they include, as every plan is different.
To help our patients file accurate claims for reimbursement, we provide detailed billing forms containing all of the appropriate codes to submit to your insurance plan. For those who would like us to submit the claims on their behalf, we are happy to do so.
More information is provided below in the FAQ’s, or you can call our office to discuss in detail with our patient coordinator on 042473100.
Why doesn’t Novomed Integrative Medicine accept my Insurance?
Our integrative medicinal physicians feel that insurance companies should not set restrictions on the level of patient care available to you may it be medical testing or treatment. Providing patient care outside of the insurance restrictions allows our physicians to take their time to comfort and support you through your concerns and discuss appropriate treatment. Operating outside the insurance system also allows our physicians to provide you with a customized treatment plan that may include “Functional and Complementary Medicine” techniques, genetic testing, food allergy tests or heavy metal tests that may not be accepted by some insurance companies. The medical treatment you receive should be the best possible care, and should be determined by you and your doctor, not your insurance company.
Does my Insurance cover Novomed Executive Health Packages?
If your insurance policy has out-of-network benefits, a portion of charges may be covered for the executive health package. Before your first visit, it is best to talk with your insurance provider to determine which elements of the health package they will or will not cover. Alternatively, you can talk to our patient support team about your out-of-network benefits and what they include, as every plan is different.
Does the Novomed Integrative Medicine accept insurance for my labs, ultrasounds and X-rays?
Dr Heather Eade and Dr Astrid do not accept insurance. However, other team members such as our GP’s, family practice consultants, internists, endocrinologists and physical therapists accept insurance. These physicians will provide treatment which covers some of the lab’s tests, ultrasounds or radiology tests you may need. Insurance providers often provide partial payment towards our executive health check-ups, its best to check with your policy provider to determine which tests they cover. The Integrative Novomed Psychiatry team and our lung specialist, allergist and sleep specialist do accept insurance. Acupuncture and cupping (Hijama) are usually covered by Theqa insurance.
If you are in doubt what tests are covered by your policy, please refer to your insurance provider.
What should I ask my insurance company when I inquire about my out-of-network benefits?
Ask your insurance company to provide you with the answers to the following 4 questions:
“What is my out-of-network deductible?”
“Is my out-of-network deductible separate from my in-network deductible?”
“What is my co-insurance?”
“What is the maximum amount of out-of-pocket expenses I will be required to pay annually?”.
Does Novomed offer financing?
We at Novomed understand that not all patients or potential patients have the financial means to pay for medical services out of their pocket.
Your out-of-network benefits and possible reimbursement may account towards a proportion of the charges, but financial hardship may still exist. Novomed wants to let you know that we work with three banks (Emirates NBD, ADCB and Emirates Islamic Bank) that offer one year’s interest free financing if you use their credit cards.
Novomed is not affiliated with those banks in any way and has no financial relationship with those banks. This is not an endorsement of their services. Information provided does not imply endorsement of these banks’ services and is presented by Novomed without any representation, guaranty, or warranty regarding its services. As with all important financial decisions, you should proceed carefully and/or consult with a financial advisor before making any decision.
My doctor has recommended PRP (platelet-rich plasma) therapy to treat my arthritis in my knee. Will my insurance cover this procedure?
Most insurance providers have their reimbursement policies available on their websites. We encourage you to contact your provider and confirm they cover the procedure in question.
Novomed helped me file my insurance claims and my claim was denied. Is Novomed going to appeal my claim?
The Novomed team assists in filing a “clean” claim with your insurance provider, meaning we ensure that the claim is correctly coded.
We also submit the form in the layout preferred by your insurer, so that it will be processed faster and more accurately.
Claims denied for contract limitations are not the responsibility of Novomed. The claims which are denied in error due to poor insurance company adjudication practices are also not the responsibility of Novomed.
These claims must be appealed by a telephone request for redetermination or by written appeal. Please be sure to file your appeal within the timeframe given by your insurance provider; otherwise, you may lose your right to appeal.
Please be sure to document the following:
The date you called,
The name of the person with whom you spoke,
What was said,
If your employer provides you insurance cover and you find your claims are being denied repeatedly, you should report the problem to your company’s Human Resources Department, so they can intervene on your behalf. Otherwise, you should consider finding a new insurance provider.
I usually file my own claims, but sometimes I ask Novomed to file my claims for me. When I do, my claims seem to get paid faster, while those I file are processed more slowly and sometimes get denied. Why?
When you file a claim by email, the processor must manually enter the insurance company’s computer system the following information:
The facility address where you were treated
The name of the care provider
ID numbers of the patient and provider
Corresponding diagnosis codes
Entering this information manually allows room for error for example, we have noticed that insurance company claim processors frequently code the diagnoses checked off on your fee slip from left to right, instead of properly connecting each diagnosis code with its corresponding treatment code. Without logical procedure code/diagnosis pairings, your claim will result in automatic rejection of your claim.
On the other hand, when Novomed files your claim, we do so in your insurance provider’s preferred format electronically. Treatment and diagnostic codes are correctly matched and ranked. These claim forms are almost always electronically “read” and automatically processed. The result is that most of the claims we process reach a decision quickly therefore payment is processed quicker.
I feel like my insurance company is exhausting me with denials and requests for more information. Is there anyone to help me?
You can schedule an appointment with Novomed Billing Director, to review your insurance claims and any remittance advice that your insurance provider sends to you in response to each claim for reimbursement you submit. Razan will explain your insurance company’s adjudication, advise you if your claims are being unfairly denied and tell you what you can do to appeal the decision.
Does my medical insurance cover the cost of supplements?
The non-prescription nutritional supplements that are available for purchase at Novomed’s pharmacy are not covered under your insurance company’s prescription plan. However, you can apply for reimbursement depending on your insurance policy.
Please mention the need of the prescription to your physician during your appointment, prior to purchase. The copy of your prescription must be submitted with your reimbursement request.