While many doctors have chosen not to participate in health insurance contracts, there are functional medicine practitioners who do. They may be available on respected functional medicine websites, such as The Institute for Functional Medicine.
Is functional medicine covered under 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 medicine doctors not covered by insurance?
Patrick: Yes, and this confirms what a lot of people think about what happens there. What makes your perspective so compelling is that you’ve been on the inside of it, and you understand how the system works and how it maintains a situation 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 first started working in the insurance industry, I don’t believe chiropractic care 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 providing the best 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 increasingly becoming for-profit businesses, which was not the case when I was growing up.
They were all previously run on a non-profit basis. It is only in the last few decades that the majority of them have transformed into for-profit corporations with this slavish devotion 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 data accumulates, health insurers would be eager to embrace a long-term-beneficial approach to medicine, but that does not appear to be the case.
Wendell: No, that is not true. Someone said, and it wasn’t me, that we don’t have a true health-care system in this country. We have a disease management industry, and many health care providers, including most pharmaceutical companies, aren’t particularly interested in getting 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 research 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 costs are rising, and they don’t seem to mind devoting 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.
Does insurance cover alternative medicine?
In many aspects, an alternative medicine practitioner follows the same treatment protocols as a conventional medical doctor. However, many insurance companies do not cover or just fund these consultations since alternative medicine is still regarded outside the scope of standard health care. Before scheduling a consultation, it’s a good idea to understand the financial aspects of alternative treatment.
The majority of alternative medicine treatments are still paid for with personal funds. Despite the fact that customer demand is prompting more insurance companies to reevaluate their rules on these therapies, coverage is still limited.
The following are some of the more prevalent types of alternative medicine that insurance companies recognize:
The best thing you can do is call your insurance company and ask if the treatment you’re looking for is covered.
Even if your insurance company does cover the procedure, you should still ask the following questions:
- What is the best way for me to get this treatment? Is it necessary to get a prescription or a referral from a primary care practitioner to get the treatment?
- What practitioners am I able to observe? Is it okay if I go to any doctor I want, or do I have to go to someone in the insurance company’s network? Some insurance companies limit coverage to a network of alternative medicine practitioners, while others give at least partial coverage for alternative medicine provided by out-of-network doctors.
- How many visits do I have a right to? Some insurance companies set a dollar limit, while others set a limit based on the number of visits.
- Is there a deductible that I must meet before my coverage kicks in? Alternative medicine deductibles can be greater than standard medical visits, so ask this question even if you already know what your deductible is.
Because many insurance companies are still deciding whether or not to cover alternative medicine, it’s a good idea to keep track of any phone contacts you have with company personnel, as well as any bills or other written correspondence you receive. These items will be useful if a claim dispute arises in the future.
Are functional medicine doctors expensive?
The initial hour-long appointment at Vytal Health costs $300. Functional medicine doctors’ fees can vary depending on where they practice (the national average is around $450), as doctors must factor in the cost of their employees 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).
Can functional medicine doctors write prescriptions?
Is it true that functional medicine doctors 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 a disease, we focus on the underlying cause, which has proven to be extremely effective.
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.
Is a functional doctor an MD?
Physicians who practice functional medicine have completed training in traditional medical specialties, 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, societal, and environmental factors that may be affecting their health.
Functional medicine doctors try to engage patients in an open dialogue when providing care, fostering 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 field of functional medicine is “uses a systems-oriented approach and involves both the patient and the practitioner in a therapeutic partnership to address 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 who use functional medicine techniques encourage people to live healthy lifestyles, 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.
Is functional medicine covered by HSA?
Lab testing, prescription drugs, and even supplements may be reimbursed. Many functional medicine practices, such as Vytal Health, encourage you to pay for your care with your HSA or FSA dollars if you have them. It could be a straightforward way for you to get the help you need.
Do insurance companies practice medicine?
In medicine, it’s becoming more common for doctors to encounter patients who we know we could help but can’t at least not right away because their insurers have made them jump through hoops.
Does functional medicine really work?
Cleveland Clinic researchers discovered that functional medicine was associated with increases in health-related quality of life in the first retrospective cohort analysis using the functional medicine approach. The findings were just published in the Journal of the American Medical Association Network Open.
The two-year study assessed health-related quality of life in 1,595 patients treated at Cleveland Clinic’s Center for Functional Medicine and 5,657 individuals seen in general care at a family health center using PROMIS, an NIH-validated questionnaire. PROMIS is a tool that measures a patient’s overall physical and mental health and may be tracked over time, taking into account aspects such as fatigue, physical function, pain, gastrointestinal disorders, and emotional well-being.
The study compared functional medicine patients to patients seen in a primary care setting to discover if there was a link between the functional medicine paradigm of care and health-related quality of life.
The Center for Functional Medicine’s patients showed significant and long-term improvements in their PROMIS global physical health, according to the researchers. When compared to patients seen in a primary care context, participants seen at the Center for Functional Medicine showed considerably higher gains in PROMIS global physical health at 6 months. The Center for Functional Medicine saw about 31% of patients who improved their PROMIS global physical health scores by 5 points or more, which is a clinically significant shift with a discernible impact on everyday life. Twenty-two percent of primary care patients saw a 5 point or greater improvement in their scores. Patients examined by the Center for Functional Medicine demonstrated similar improvements at 12 months as they had at 6 months, although they were not statistically significant when compared to primary care patients’ improvements.
Researchers looked at continuous changes in PROMIS global physical health over time in a smaller group of patients seen by the Center for Functional Medicine at 6 and 12 months, and found that improvements in PROMIS global physical health were significantly larger than those seen in a primary care setting.
Researchers believe that distinctions in the functional medicine model itself, the categories of patients seeking functional medicine, and treatment adherence or belief in the model of care are the reasons for the improvements in health-related quality of life shown in functional medicine patients. Prospective studies on the functional medicine model of care and long-term outcomes are needed in the future.