Is Functional Medicine Covered by Insurance?
I get it. We all want our medical costs to be covered by insurance. My first question before seeing a Functional Medicine doctor was the same, “Do you take my insurance?” Then I went through the Functional Medicine process firsthand and know how completely different it is from conventional medicine. I loved it so much that I went to medical school in my mid30s, so I can provide the same type of comprehensive care that I found lacking in mainstream healthcare.
Conventional medicine today is effectively triage built around quickly matching symptoms to an insurance billing code. Patients are labeled with a reimbursable diagnostic code and then matched to its procedures and medications. Insurance pays for treating symptoms, but not uncovering the root causing the symptoms.
Functional Medicine is thoughtful with care spent on understanding your body as a cohesive, whole system. I look at the gut-brain axis, hypothalamus-pituitary-adrenal axis, gut-skin axis, how all hormones communicate with each other. I want to get to the root of why Symptom X and why your body is imbalanced, so that it allowed the illness that causes Symptom X arose in the first place. If you have digestive issues, a conventional doctor may recommend you to adopt a FODMAP diet. As your functional medicine doctor, I would work with you to understand why you have a specific food allergy and then work to improve your gut, so that you may tolerate that food again. Its a much more involved doctor-patient relationship.
A Functional Medicine doctor is spending far more time with you (both in person and afterwards researching your unique case) to get to the root of your issue. We use advanced labs that take more time and knowledge to interpret, and then personalize your treatment plan to include natural therapies. This time is not encouraged or covered by insurance.
Functional Medicine doctors understand that what works for you might not work for the other 99 people in the study, because health is personal. You have a unique genome, microbiome, and lifestyle– factors that just aren’t considered in mainstream medicine recommendations.
Insurance-free practices allows for:
Advanced care. Being “insurance-free” allows doctors to recommend the most advanced therapies and testing. One study showed that conventional doctors took an average of 17 years to change behavior, from the time of new scientific information (1). The insurance model keeps doctors stuck in the current “standard of care” because that is often what is reimbursed, even if that standard of care is outdated. Insurance covers what they can easily track (expense to benefit) and unfortunately one of the easiest things to track is medication. Medications are also easier to study because it’s one intervention and not a more difficult to measure multi-factorial approach of lifestyle and natural therapies. (Not to mention medication studies have more funding). Yes, medications can be life-saving and necessary and as an MD I still prescribe them, but it is only part of our treatment plan.
Personalized care. In functional medicine, we base treatments on the best possibilities for an individual with a unique genome, microbiome, and lifestyle, instead of basing our treatments simply on what the insurance company tells us they’ll pay for.
Time. Insurance reimburses doctors’ visits that typically last about 15 minutes. We often spend over an hour with our patients getting a comprehensive assessment. We have to know what is going on in your life before we can improve it.
Flexibility. There are no restrictions with where or how your care can be given – in office, home, phone, or video. We can meet patients where they are.
1:1 personal relationship. There’s no one in between your doctor and you. It’s a true partnership. Your doctor is only working for you. I am not caught in a triangle between you, insurance, and administration.
No barriers to seeking care and support when you need it. There are no penalties for seeing us (like co-pays). In our model, we expect to see our patients frequently so that we can help them through the healing process.
Transparency. There’s no guessing game of what’s covered, surprise lab bills in the hundreds of dollars for necessary tests that you felt should be covered. We spell out lab costs, decide together which tests are important and let you know the worst case pricing if the insurance doesn’t cover. We also offer much lower, direct pay pricing on many common labs.
We consider functional medicine an investment over an expense. Working to transform your lifestyle and health will continue to reward you over your lifetime. It’s more of a priority decision than a cost decision.
