Insurance and Functional Medicine

insurance coverage

Why doesn't insurance cover functional medicine?

  1. Insurance is intended for covering emergencies.  Our car insurance doesn't cover gas or repairs, right?  Our home insurance doesn't cover utilities or improvements, right?  Health insurance is intended to be the same.  
  2. Functional medicine treats chronic conditions.  Insurance covers acute conditions.
  3. Insurance has support from pharmaceutical companies.  Functional medicine does not.
  4. Insurance reimburses well for procedures.  Functional medicine is based on relationships and listening, not on procedures.
  5. Practices that use insurance often spend up to 40% of their time on insurance demands (charting, billing, pre-authorizations, etc).  This time is carried over to time with patients.  Instead of being on the phone for hours, arguing with an insurance representative who has no medical experience, functional medicine practitioners devote that time on behalf of the patient - combing through labs, research, and making sure every "stone is overturned" so as to avoid missing a key element of the patient's health history.
  6. Insurance reimbursement focuses on quantity, not quality, of care.  Most functional medicine practitioners are spending up to an hour or more at each patient visit, creating a relationship/partnership with the patient.  

Although most functional medicine providers are not using insurance, they will often provide the itemized invoice needed for a patient to submit a "super bill" to his/her insurance, work that the practitioner's office would typically be doing.  It is up to the insurance to determine whether they will cover all, some, or none of the visit.  

Also, most functional medicine practitioners utilize blood tests, which insurance may cover.  It is ultimately up to the individual insurance plan.

And finally, FSA and HSA (flex spending or health savings accounts) are options for payment.