Is Functional Medicine Covered By Insurance

Is functional medicine covered by insurance?

What’s the difference between the two models of care?

In addition, if your doctor is spending enough time with you (both in person and afterwards researching your unique case) to get to the root of your issue, using advanced testing that takes more time and knowledge to interpret, and then personalizing your treatment plan to include natural therapies, the most likely answer is no, it’s not covered by insurance.

So, a true functional medicine approach doesn’t often work with insurance.  However, here’s why that can be a good thing:
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stuck in the current “standard of care” because that is often what is reimbursed, even if that standard of care is outdated.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.  Read one of our member's stories here.
• Time.  Insurance reimburses doctors’ visits that typically last about 15 minutes. We often spend over an hour with our new members, 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. Being completely virtual keeps people on track for the long term via home, travel, and work. 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. He or she is 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.  

But, functional medicine is expensive, right?

Functional medicine is not more expensive than repeat colonoscopies, ongoing work-ups with no answers and expensive imaging, “blockbuster medications” that only increase in dose and number, or an emergency that could have been prevented.

• Digital meal plan downloads.  After all, nutrition lays the foundation for success in functional medicine.   
• Root supplements. These are professional grade, third-party-tested supplements that we actually use in practice, available to you now. We test levels in real people and see the results in real life from our supplements.  We even created bundles using some of our popular protocols, such as our gut health bundle, so that anyone can access a gut healing regimen.
• HSA/FSA dollars are often able to be used for our medical and dietitian consults (check with your carrier). This can give you more control over your health care dollars. Now, as many insurance plans have higher deductibles, many employers offer HSAs as part of the health plan.
• The savings we are able to pass on to patients on direct lower cost conventional labs can offset the total cost of functional care.