Insurance coverage can be a tricky subject to navigate. Many clinics are dealing with whether or not functional medicine doctors are covered by their insurance, with functional medicine increasing in popularity.
The short answer to whether or not functional medicine is covered by insurance is that it depends. The answer is probably no, but that doesn’t necessarily mean you can’t use your insurance for functional medicine. Unfortunately, there isn’t any functional medicine health care plan available, so it is a complex ordeal.
Maybe you haven’t worked with a functional medicine doctor yet. If you’re interested in utilizing functional medicine but want coverage by your insurance, below you will find some information and what you should know regarding functional medicine coverage by insurance.
What is Functional Medicine?
Functional medicine, sometimes also referred to as holistic medicine, prioritizes complex and multifaceted health problems within an individual. Some examples include chronic pain, inflammatory diseases, and depression, with the goal to heal by determining the root cause of the disease and promoting a healthy lifestyle. Prevention of the illness or health problem is the foundation of functional medicine.
Many times, people, particularly women, will ignore symptoms of a severe health problem to put others before themselves. Moms worry more about their children sprouting signs and put their needs on the back burner. However, with functional medicine, the primary goal is to focus on YOU, providing self-care and prevention of potentially serious health threats, such as a heart attack, stroke, or diabetes.
Women tend to dismiss initial feelings of unwellness as if it is not of concern. Women have different signs that could indicate heart disease than men do, including neck, jaw, shoulder, and abdomen discomfort. These symptoms are not consistently recognized as the standard chest pain or arm pain associated with a heart attack.
Another example would be looking t your gastrointestinal health. For example, instead of dealing with multiple medications for issues like Irritable Bowel Syndrome (IBS), a functional medicine prognosis might be to look at your diet and change how you are eating to help manage and treat the problem.
Functional medicine can help you become more in tune with your body and help you understand when you may need more attention. In addition, functional medicine doctors will help you learn how to sustain healthier habits and a lifestyle for longevity.
Difference Between Conventional Medicine & Functional Medicine
Traditional medical insurance is oriented toward conventional medicine and acute care, which is the diagnosis and treatment of illnesses in a more short duration. For example, if you broke an arm or needed your appendix removed, this would be considered acute care.
Those tests, x-rays, procedures, and services provided by the doctor are covered by the conventional medicine model. Your insurance company does not offer much coverage in visits where you identify the root cause of your problems; they are more specific to lab tests and procedures for diagnosis.
A significant difference between functional and integrative medicine is that the functional approach will help you answer the “why” surrounding your healthcare issues. It can be beneficial to query healthcare insurance to see what their policies will cover.
Functional Medicine Expense
The cost of functional medicine can be expensive; however, when you look at its benefits, you should consider the price more of an investment over an expense. It is not more costly than multiple ongoing workups with no results after various medications.
If you are willing to invest in your health and make it a priority, you are making the most intelligent decision by working with a functional medicine doctor. You can change the course of your health with lifestyle changes and see results over time without continuing to experience chronic illness and having no direction on how to relieve it.
Insurance and Functional Medicine
Functional medicine treatments are deemed alternative because they don’t involve obtaining medication for symptoms. Instead, functional medicine doctors at Rahav Wellness work with you individually to help you locate the unique factors that make up your health and determine how to diagnose or prevent your issues. Unfortunately, for this reason, the functional medicine approach doesn’t work with insurance.
However, it can be beneficial that you don’t utilize insurance when going the functional medicine route. Why? There are multiple advantages that you can take with insurance-free practice, such as:
- Personalized care – functional medicine works to find treatments to help you specifically, instead of just treating a symptom or condition; what the insurance companies tell doctors they will pay for.
- Time – There is no limit to how long your doctor’s session will last; with typical doctor visits and check-ups, there is a limit of about 15 to 20 minutes. Functional medicine doctors will work with you for over an hour to ensure they are obtaining a fully comprehensive assessment of your health.
- Without insurance, doctors can recommend more advanced treatments for testing and therapy instead of going with the standard of care covered by insurance.
- Transparency – there is no guesswork involved in what is covered, where a surprise lab bill might show up when getting tests done that your insurance didn’t cover from a visit. Your laboratory costs and testing prices will be made clear to you so that you are aware of what is covered, if anything, by your insurance upfront.
While it is still very much encouraged to have insurance and try to bill them to see what could be covered, there are other ways that the functional medicine care cost can be reduced for you. For example, online programs are usually offered at a discounted price. You also can often utilize a Flexible Spending Account or Health Savings Account through your medical insurance for medical and dietitian consults.
Exploring Functional Medicine Options
As is with any insurance, you should consult with your carrier to see what is (or isn’t) covered across the functional medicine realm. You can also ask the functional medicine clinic or office directly if they offer lower-cost care. There may be savings that can be passed onto you that will help offset the total expense of your care.
Both cost and treatment will depend solely on you and your needs. Your doctor will work with you to find the most effective treatment and get you to the point where you no longer need treatment.
Functional medicine is constantly expanding, and with many people recognizing the need to prioritize their health, it will become a much more mainstream way of care. Therefore, it should be no surprise that insurance will have to recognize this health approach soon and cover the care that helps diagnose the root problem of health concerns for an improved, lasting life.
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