Are you a health coach or wellness provider wondering if you can, or even should, bill health insurance companies for your services? Perhaps you have started your wellness practice or your virtual holistic health practice and some of your clients are asking if you take insurance. Or perhaps you are wondering if it is a good idea to take insurance.

Certainly health insurance offers another revenue stream, particularly from those clients who may not be able to afford to pay a functional medicine or lifestyle medicine practitioner cash. The whole idea of increasing access to more disadvantaged clients, such as those clients who might qualify for Medicaid or Medicare, is a topic worth discussing at length in a separate article. Indeed, I have encountered some health practitioners who deem it an ethical obligation to service individuals who are eligible for Medicaid and other low-income assistance programs.

But I have also encountered countless health care practitioners who have escaped the traditional health care system because of the bureaucracy, paperwork and regulatory burdens that plague the health care industry. The wellness industry, by contrast, offers freedom and relief from those institutional and regulatory burdens. And a big contributor to a lot of those burdens relates to billing insurance. When health care providers bill insurance, they all of a sudden become “covered entities” who are subject to complying with the Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules. We have written about HIPAA compliance for wellness practitioners here.

Billing insurance also means having to comply with each health insurer’s billing requirements, entering into provider contracts with those insurers, and being subject to possible audit and evaluation of your practice. It also means not being able to set your own prices – insurers will pay you what they think your services are worth and nothing more.

So while billing insurance may have the advantage of increasing the number of potential clients, it brings with it a host of compliance issues and restrictions.

Right now, however, most wellness practitioners deliver services that are not covered by health insurance. So, for most holistic health providers, billing health insurance isn’t even an option even if they wanted to submit bills to health insurers. Some groups, like the National Board on Health and Wellness Coaching (NBHWC) are trying to change that by advocating for CPT Codes to be assigned to health coaching services. Indeed, some CPT Codes have been approved for health and well-being coaching since January 1, 2020. The US Department of Veterans Affairs is using these codes. But, private payers, such as health insurance companies, do not have to recognize these CPT Codes and therefore do not have to reimburse for health coaching services.

Before wellness practitioners as a group decide whether it is a good idea to advocate for widespread use of CPT Codes and the ability to bill insurance, they should be prepared for all of the compliance standards that will accompany such effort. The wellness industry will also need to evaluate whether it wants to give up its status as a refuge from the traditional health care industry that comprises hospitals, physician clinics, and health insurance companies. Currently, wellness offers freedom to deliver holistic and lifestyle health services in a way that conventional medical practices can only dream about. As soon as wellness adopts similar payment systems as traditional health care, much of that freedom will likely disappear. The tradeoff will be more credibility, legitimacy and access to wellness services, and those are lofty goals. But with more recognition by insurers will likely come more recognition from competing providers, many of whom will likely be licensed professionals who will feel like wellness professionals who are not licensed by any state authority should not be worthy of such recognition. As a result, wellness providers should be ready for such battles and understand what is likely to come should this effort to bill insurance continue.

The Center for Health and Wellness Law, LLC is here to help the wellness industry navigate these potential road bumps. We specialize in wellness law and believe in the services wellness providers deliver. Please contact us to be your wellness law resource today by scheduling a free 15 minute consult here.

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