Why Is Functional Medicine Not Covered By Insurance?

Functional medicine is expanding at a breakneck pace, but most health insurance policies don’t reflect this.

According to Grand View Research, the global market for “alternative and complementary medicine” is predicted to reach $296.3 billion by 2027. Given how little attention holistic approaches to medicine receive from health insurers, this is a significant achievement.

Wendell Potter, a best-selling author and former high-ranking health insurance executive who unexpectedly quit his position and became the industry’s most outspoken critic, looked like the right person to talk to about this. He’s published two books since then that expose the greed and corruption in the health insurance industry, and he’s also the founder of many non-profit organizations campaigning for change.

On Changing Healthcare, I had the pleasure of interviewing Wendell, and you can read our conversation here. For length and readability, it has been somewhat altered.

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.

Is functional medicine worth the money?

As a result, we’ve arrived at the crux of the matter. Is it worthwhile to pursue functional holistic medicine? Functional medicine is worth it for you if you answered YES to the above questions!

Understanding the level of dedication required for any type of alternative medicine is critical to treatment effectiveness. If you’re weary of being sick, willing to try new things, and ready to go outside of your comfort zone, functional medicine is well worth your time and money.

Functional medicine is a type of medicine that can be used to address a variety of health problems. On our services page, you’ll find a list of ailments for which functional medicine can be used as a treatment option.

It’s time to undertake some real soul searching and questioning. We’d love to hear from you if you’re becoming increasingly interested in the benefits of functional medicine.

  • https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name

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 greatest thing you can do is phone your insurance provider and inquire 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 like, 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 have a price 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 disagreement arises in the future.

Why are holistic doctors not covered by insurance?

Holistic medicine is a type of complementary and alternative medicine. According to the National Institute of Health, some alternative treatments, such as chiropractic, acupuncture, and massage, may be covered by insurance companies. However, most insurance companies do not cover holistic medicine. Herbal therapy, homeopathy, hypnotherapy, naturopathy, and yoga are examples of alternative medicine that are not covered by health insurance programs. Because it has not been scientifically demonstrated to be successful in treating medical ailments, insurance companies do not pay this form of treatment.

Is naturopathy the same as functional medicine?

“It takes a village to raise a child,” as the saying goes. Even though I’d heard it many times before, it wasn’t until my daughter’s birth that I completely understood what it meant. I’d like to believe the same holds true for your health. To support your well-being, you’ll need the help of a group of people. You don’t have to come to that realization after being diagnosed with a serious illness. On any given day, prevention is preferable to cure.

The information in this page is not intended to be used as medical advice. It is not intended for use in the diagnosis, treatment, cure, or prevention of any disease. It’s simply intended to broaden your horizons in terms of holistic health and wellbeing.

What is Functional Medicine?

The goal of functional medicine is to identify the disease’s drivers: what is causing the illness in the first place? Unlike traditional medicine, where symptoms are often only treated by matching a patient to a pill (which may only act as camouflage).

Doctors that practice Functional Medicine have received certified medical training and have clinical experience. They can detect and treat a wide range of ailments and major health issues. They look at genetic, lifestyle, environmental, and family histories to treat the body as one integrated system. If your blood tests are “normal,” but you’re still not feeling well, functional medicine testing can identify hormonal, metabolic, and nutritional imbalances that a routine blood test can’t detect.

In this brief video, Dr. Mark Hyman, a pioneer in this field, illustrates the key differences between functional and conventional medicine. Functional Medicine’s gold standard is the Institute for Functional Medicine. They provide a search tool that will help you find a certified Functional Medicine practitioner anywhere on the planet.

What is Naturopathy?

Naturopathy follows the same concepts as Functional Medicine in that it treats the full individual rather than just the problem region. Naturopaths, on the other hand, are not medical doctors. They are unable to diagnose illnesses or issue prescriptions. They are known as Naturopathic Doctors, or NDs, and have received medical training.

Naturopathy is based on the belief that the body is self-healing, hence therapies provided by Naturopaths will often include nutritional supplements, herbs, food and lifestyle counseling to aid the body’s natural healing capabilities.

Naturopathy can help you even if you aren’t sick. It’s a technique for restoring body harmony and preventing disease, as well as treating a variety of ailments like exhaustion, stress-related symptoms, and digestive issues, to mention a few.

Naturopaths frequently specialize in a particular area, such as hormones, digestion, or skin problems. It’s not uncommon to find a Naturopath who also holds a certification in nutrition or herbal medicine. Naturopathy can be a wonderful addition to whatever medical treatment you’re receiving from your Functional Medicine practitioner.

Some resources to help you

Look for the appropriate certifying authority in your nation to discover a practitioner. The Australian Natural Therapists Association is based in Australia, while the American Association of Naturopathic Physicians is based in the United States.

Contact me for additional support

The problem is that Functional Medicine Doctors and Naturopaths only have so much time to devote to you. I know firsthand how difficult it was to acquire answers to my questions in between appointments. In order to change my lifestyle and optimize my treatment, I sometimes had to spend hours reading and trying. That’s what I can help you with as a Life Coach and Wellbeing Consultant: maximizing your chances of success with the treatment you’re receiving and staying focused on finishing it. Check out my Holistic Wellbeing service HERE.

How much does a functional medicine doctor cost?

Due to the fact that most functional medicine specialists do not accept health insurance, there are understandable concerns and concerns about the cost of functional medicine. How much does a visit to a functional medicine doctor cost? What tests will I require and how much will these exams cost? How many visits will I be required to make? Is it feasible to locate a functional medicine physician who accepts insurance? All of these queries have the same answer: it depends.

Initial Visit and Associated Costs

The first appointment to a functional medicine practitioner is sometimes the most time-consuming and intensive. The clinician gathers a complete personal and family history, looks for any probable environmental factors that may be contributing to the patient’s chronic diseases, and gets a sense of any other lifestyle or behavioral aspects that may be at play (i.e. smoking, nutritional patterns, stress and stress management). Your doctors will be able to pinpoint the source of your ailment and design a treatment strategy based on this complete understanding of your baseline health, habits, and environmental inputs.

The cost of these visits varies widely depending on criteria such as location, competence, overhead, and other variables. Functional medicine practitioners often charge roughly $460 per hour on average. Of course, most appointments aren’t an hour long, and some providers provide bundles or packages that contain a specified number of visits for a given price over time.

Transparency is far more required in the realm of functional medicine, regardless of what a practitioner charges or how they arrange their billing; this is one of the many advantages of operating outside of the health insurance industry. It’s quite normal to inquire about the cost of each visit and test before arranging an appointment with a functional medicine practitioner.

Average Costs for Common Tests

The costs of the many tests and diagnostics that may be ordered are also highly transparent, in addition to the greater transparency around office visit fees with a functional medicine doctor. Unlike traditional medicine doctors, who are frequently unable to predict the cost of a test or prescription that they may order, functional medicine doctors are well-versed in the costs set by the providers with whom they work.

When recommending multiple tests, functional medicine practitioners frequently discuss the expenses involved with those tests so that their patients can make an informed decision about which tests to prioritize if all are not feasible.

Simple breath tests, stool testing, examination of any potential food allergies, and hormone panels are some of the most routinely ordered tests and diagnostics. Though the cost of these tests varies by region, lab, and provider, the average cost per test is between $200 and $700. While some of these parts may be covered by insurance, this varies and should be investigated on a case-by-case basis.

Can functional medicine help anxiety?

Remove harmful influences on brain health and replace them with healthy, functional nutrition, meals, and coping mechanisms, according to the functional integrative and internal medicine approach to anxiety and depression.

Are functional doctors good?

While traditional medicine is excellent at addressing acute and emergency medical problems, functional medicine is better suited to chronic sickness, according to Dr. “The majority of my patients have seen traditional doctors but have not received appropriate treatment.

What is the difference between holistic and functional medicine?

A holistic doctor treats the individual, not the sickness, through a variety of therapies. Holistic practitioners think that if one part of the body is in pain, it can affect the entire body, so this form of medicine focuses on treating the full person, including their physical, emotional, and spiritual well-being.

Traditional drugs are combined with drug-free treatments such as lifestyle and nutritional adjustments, acupuncture, counseling, homeopathy (the use of natural substances such as plants and minerals to improve overall health), and chiropractic care by doctors in this profession.

Integrative Medicine:

Integrative medicine is a kind of holistic medicine that addresses the whole person and incorporates treatments such as homeopathy, acupuncture, nutritional therapy, massage, and yoga into modern healthcare.

An integrative medicine doctor uses traditional diagnoses, conducts blood tests and EKGs, and may offer less conventional treatments in addition to standard treatments, with the goal of reducing pharmaceutical use.

Functional Medicine:

Functional medicine takes a holistic approach to treating each patient as a whole, focusing on the underlying reasons rather than the symptoms. A functional medicine doctor and patient create a tight bond, working together to achieve a healthy balance and repair the body.

Functional medicine is highly personalized health care that considers a patient’s history, genetics, environment, and lifestyle, and favors nutritional therapy, exercise, supplements, hormone therapy, and natural treatments over drugs or surgery because each patient is genetically and biochemically unique.

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 monies if you have them. It could be a straightforward approach for you to get the help you need.