Are Functional Medicine Doctors Covered By Insurance?

If you’re in a true functional medicine practice, where your doctor follows a functional medicine model of treatment rather than a traditional insurance one, the answer is almost certainly no, it’s not covered by insurance.

Why are functional doctors not covered by insurance?

Patrick: Yes, and this confirms what a lot of people think about what happens there. What makes your position so compelling is that you’ve been on the inside of it, and you understand how the system works and how it maintains a scenario in which people pay exorbitant premiums for health insurance and receive very little affordable care in return.

This is an excellent segue into the fact that so-called “alternative care” services like functional medicine, acupuncture, and chiropractic care have very limited coverage. In fact, many small and medium-sized businesses don’t mention them at all in their strategies, right? However, demand for functional medical services has been steadily increasing. So, as someone who has been on the inside, can you tell us what health insurers are talking about when it comes to natural medicine internally?

Wendell: Well, it isn’t talked about nearly as much as it should be. It can take years for something to be covered as a benefit.

When I initially started working in the insurance industry, I don’t believe chiropractic therapy was covered under many, if any, of my company’s benefit plans. As a result, it takes time.

To be honest, there is a lot more discussion about how to achieve the profit expectations of shareholders. How do you prevent having to pay claims? How can medical expenses be managed in a way that maximizes profits? Those are the kinds of discussions that take place in real life.

During at least the last ten years of my career, I don’t recall ever being in a meeting where there was a genuine discussion about what is best for the health plan members. It’s all about what’s best for the company’s stockholders. The top executives are always also shareholders. As a result, they have a financial stake in maximizing profits, because the more money the company makes, the more money they get. As a result, there isn’t much discussion regarding. Period.

Patrick: On the surface, it appears to be indistinguishable from auto insurance, right? You’re attempting to reduce risk. You’re putting money into a system in exchange for benefits. People, on the other hand, believe that health insurers are giving the finest possible care, even if it is costly. They may not realize that the underlying discourse going on there is about how to maximize shareholder profitability, but I suppose I’m simply naive.

Wendell: The issue is that health insurance companies are gradually becoming for-profit businesses, which was not the case when I was growing up.

They were all formerly run on a non-profit basis. It is only in the last several decades that the majority of them have transformed into for-profit corporations with this obsessive dedication to the shareholder. As a result, something has worked against the interests of the rest of us. Again, I believe that non-profit insurance corporations were not getting in between a doctor and his or her patients, clinicians, or practitioners back in the day, but that has changed. All too often, erecting barriers to care is the best way to maximize earnings.

Patrick: I’ve always considered that with conventional medicine, on the one hand, it’s commonly understood that they’re primarily concerned with disease management.

Patrick: Prescription drugs are used to treat acute disorders, but functional medicine focuses on addressing the core cause, which is frequently a hormone imbalance, a problem with the gut, or something that has a domino effect on their metabolic systems. You’d think that as more evidence accumulates, health insurers would be ready to embrace a long-term-beneficial approach to treatment, but that does not appear to be the case.

Wendell: No, that is not true. Someone stated, and it wasn’t me, that we don’t have a true health-care system in this nation. We have a disease management industry, and many health care professionals, including most pharmaceutical corporations, aren’t very interested in making you well.

They’d prefer to keep you on maintenance medication for the rest of your life. That is how they earn a living.

There has been very little investigation into anything that could be used as a substitute for that type of profit-making. There are other things that have a role as well.

To be honest, insurance firms aren’t particularly concerned with cost-cutting. They don’t want to pay claims, but they don’t seem to mind that health-care expenses are rising, and they don’t seem to mind dedicating a lot of resources, time, and attention to keeping people healthy and preventing them from becoming sick in the first place. Because the insurance industry has a high rate of churn. You may be a member of Aetena today and Cigna next month. As a result, there is a lot of churn, and insurance companies do not believe it is profitable to spend a lot of time and resources on individual health plan customers.

What is functional medicine covered by insurance?

Many parts of your care with a functional medicine practitioner are covered by insurance, even if your functional medicine care isn’t. Blood tests, as well as x-rays and other radiological tests like CT scans and MRIs, are frequently covered by insurance.

Are functional medicine doctors expensive?

The initial hour-long appointment at Vytal Health costs $300. Functional medicine doctors’ fees might vary depending on where they practice (the national average is roughly $450), as doctors must factor in the cost of their workers and office space, which can drive up the price. We are able to keep our hourly fees cheaper than most other clinics since Vytal Health doctors are fully virtual (on-line).

Does insurance cover alternative therapies?

Many insurance companies are beginning to reimburse at least a portion of the costs associated with more commonly regarded alternative and integrative therapies. Acupuncture, chiropractic therapy, and massage, for example, are frequently included. If you’re thinking about considering a supplementary therapy, check with your insurance company to see what your plan covers. You might wish to inquire of them:

  • Is there any coverage for in my insurance policy? If so, how much and for how long is coverage provided?
  • Is it necessary for me to see a practitioner in my network? If that’s the case, will I be covered if I leave the network?

Get your doctor to provide you a reference or a recommendation for the complementary therapy you want to employ if at all possible. Many insurance companies demand that the method be demonstrated to be reasonable and medically required, and having your doctor’s endorsement may be useful later on.

Can functional medicine doctors write prescriptions?

Is it true that functional medicine practitioners can prescribe medication? This is a frequently asked question. Yes, to put it succinctly. Functional medicine doctors are licensed physicians who can write prescriptions as necessary. We, on the other hand, vary from traditional doctors in that we treat each person as a whole, with the goal of restoring their complete health. This means that rather than treating the symptoms of an illness, we focus on the underlying cause, which has proven to be extremely beneficial.

We’ll walk you through the many types of functional medicine practitioners in this blog so you can understand what they do and what makes our practice unique. We’ll also go through what we treat, go over some treatment options and benefits, and leave you with some questions to ponder so you can decide if functional medicine is suitable for you.

Are functional medicine doctors legitimate?

Functional medicine is a type of complementary medicine that includes a variety of untested and unproven approaches and treatments. Its proponents argue that it concentrates on the “root causes” of diseases by developing “individualized treatment regimens” based on interactions between the environment and the gastrointestinal, endocrine, and immunological systems. Pseudoscience, quackery, and a rebranding of complementary and alternative medicine have all been used to describe it.

The American Academy of Family Physicians has declared that functional medicine techniques are unsuitable for course credit in the United States due to concerns that they may be hazardous.

What is the difference between a functional doctor and a regular doctor?

Traditional medicine just looks at individual symptoms and assumes they’re linked to different bodily sections. Functional medicine allows you and your doctor to assess your symptoms in order to determine which physiological systems are affected.

Does Mayo Clinic have functional medicine doctors?

Integrative medicine professionals at Mayo Clinic pay attention to your issues. They may recommend therapies that can be incorporated into your overall treatment plan. Research that is unique. Your care team’s evidence-based recommendations have been thoroughly tested for efficacy and safety.

Are functional doctors MDS?

Physicians that practice functional medicine have completed training in standard medical areas, but they focus on providing more patient-centered care (as opposed to traditional care, which is typically centered on treating symptoms). Rather than treating patients for each individual symptom, functional medicine specialists focus on the underlying causes of symptoms and illnesses. These doctors provide comprehensive care for patients, taking into account physical, emotional, mental, sociological, and environmental variables that may be affecting their health.

Functional medicine professionals try to engage patients in an open discourse when giving care, building a close and honest doctor-patient relationship. By allowing the patient to open up to the doctor, the doctor is better equipped to provide comprehensive medical care and treat the underlying causes of sickness and illness. According to the Institute for Functional Medicine, the area of functional medicine is “takes a systems-oriented approach and involves both the patient and the practitioner in a therapy partnership to treat the underlying causes of disease.”

Patients have the greatest capacity to influence their own health, thus functional medicine physicians focus their care on them. Doctors that use functional medicine practices encourage people to live healthy lives, which include eating a balanced diet and exercising regularly, as well as maintaining good mental, emotional, and social health. Some functional physicians may incorporate various forms of “alternative” or complementary medicine in addition to typical “Western” medical procedures “Acupuncture, for example, is an example of “integrative” medical techniques.

Functional Medicine Education & Training

Functional medicine practitioners may be trained in a variety of medical areas. A fellowship or residency is required for certification by a medical specialty board certified by the American Board of Medical Specialties after completing a bachelor’s degree from a four-year college and then an MD or DO degree from an accredited medical school (ABMS).

After completing their study, an MD or DO can opt to work as a functional medicine practitioner, focusing on identifying the root causes of illness and disease and creating a personal relationship with patients. This tight contact allows the functional medicine practitioner to have a better understanding of how the patient’s body works, which he or she then uses to create individualized programs for each patient.