Is Functional Medicine Covered By Insurance

Is functional medicine covered by insurance? This is a sensitive subject, and we often get this question as it pertains to many individuals. We have chosen a model that allows us to provide the best individual care in a holistic functional medicine practice. Please explain the answer to this question, as it is a subject that is sensitive for many and requires a careful response.

Is functional medicine covered by insurance?

No, it is not included in the insurance coverage; the most probable explanation is that if you are receiving treatment from a genuine functional medicine practice, your doctor is likely following a functional medicine approach to care rather than a traditional insurance-based model.

What’s the difference between the two models of care?

Conventional medicine, which is based on insurance, revolves around the concept of labeling a finding or diagnosis with a reimbursable diagnostic code and matching it to the appropriate procedure or medications.

The core of functional medicine is finding the root cause of why medication doesn’t fit simply into the diagnosis and operating. We remove the artificial silos of specialty areas in conventional medicine, considering you as a whole person with communication between body organs/systems and mind. The functional medicine model works through the matrix of imbalances and balances, considering the mind-body connection and the spirit, often not labeling your symptoms with a single diagnostic name.

In addition, if your doctor is spending enough time with you (both in person and afterwards researching your unique case) to get to the root of your issue, using advanced testing that takes more time and knowledge to interpret, and then personalizing your treatment plan to include natural therapies, the most likely answer is no, it’s not covered by insurance.

Many treatments in functional medicine are considered “alternative” because they don’t involve medication for symptoms, but rather a unique lifestyle and microbiome genome factors that work for you, as the study suggests that mainstream medicine recommendations might not work for you since you have a unique functional medicine needs. Doctors understand what works for you in functional medicine, so they might recommend a supplement instead of medication.

So, a true functional medicine approach doesn’t often work with insurance. However, here’s why that can be a good thing:Insurance-free practices allows for:

Being an MD, I still prescribe medications as necessary and life-saving, but I also acknowledge that a treatment plan should involve a multi-factorial approach that includes natural therapies and lifestyle interventions. Medications are easier to study and track for their benefits and expenses, as they are typically covered by insurance. However, the current insurance model often keeps doctors stuck in outdated standards of care, leading to a delay in adopting new scientific information and behavior change. One study showed that it took an average of 17 years for conventional doctors to embrace new information. By practicing “insurance-free” care, doctors have the freedom to recommend the most advanced testing and therapies. This allows for more advanced care to be provided.

Read one of the stories of our members here. In functional medicine, we prioritize treatments based on the best options for an individual with a distinct genome, microbiome, and lifestyle, rather than solely relying on what the insurance company indicates they will cover. This approach ensures personalized care.

It is common for our new members to spend over an hour getting a comprehensive assessment. We often invest this time to enhance our understanding of what is happening in your life before we can make improvements. Insurance providers typically cover the cost of these doctor visits, which usually last about 15 minutes.

Flexibility. We can meet patients wherever they are. There are no limitations on where or how your care can be provided – whether it’s in the office, at home, over the phone, or via video.

The relationship between administration, insurance, and the doctor does not form a triangle that involves you. Your doctor exclusively works for you, creating a genuine partnership. No intermediary exists between you and your doctor, fostering a personalized 1:1 connection.

In our model, we expect to frequently see our patients through the healing process, helping them and providing the necessary support and care without any penalties or barriers, such as co-pays.

The data lab we have is invaluable. Although we don’t go through insurance, we are able to pass on savings to you since our program is actually valued at about $2100 per member. The value of our Root panel lab is known to be about $2100. Additionally, we also offer much lower pricing on many common labs. We make sure to spell out the costs for important tests, so you know the worst-case pricing if insurance doesn’t cover it. We believe that necessary tests should be covered and that you shouldn’t be surprised with lab bills amounting to hundreds of dollars.

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But, functional medicine is expensive, right?

Throughout your lifetime, putting effort into changing your way of life and well-being will consistently benefit you. Functional medicine is viewed as a worthwhile investment rather than a mere cost. First and foremost, we take it into account.

Functional medicine is not more expensive than repeat colonoscopies, ongoing work-ups with no answers and expensive imaging, “blockbuster medications” that only increase in dose and number, or an emergency that could have been prevented.

We see people from all walks of life, including hardworking individuals on a fixed budget, who are willing to invest in their health. It is more of a priority for them to invest in their health rather than considering it as a cost. They make an upfront investment, expecting different results by taking the same medications and doing the same things, instead of waiting and keeping the same course.

We provide multiple choices for accessing our functional medicine protocols at different price ranges. While we do not directly collaborate with insurance, we highly recommend our patients to have insurance coverage, particularly for urgent medical requirements.

Digital meal plan downloads. After all, nourishment establishes the groundwork for triumph in functional medicine.

Now you have access to professional-quality supplements that have been tested by third parties, which we personally utilize in our practice. Through our supplements, we witness real-life outcomes and examine levels in actual individuals. Anyone can obtain a regimen for healing their gut by utilizing certain widely-used protocols, like our gut health bundle. We have even developed bundles incorporating some of our well-received protocols. These supplements serve as fundamental support for overall well-being.

Many insurance plans now offer HSAs as part of the health plan, which allows you to consult a dietitian and use your HSA/FSA dollars more frequently (please check with your carrier). This can give you more control over your health care dollars. Many employers offer HSAs with higher deductibles.

We are able to pass on savings to patients by offsetting the total cost of functional care with lower conventional lab costs.

Gut Health Bundle

Our three most popular digestive health supplements packaged together for a 10% discount.

$142.00.

Thyroid Health Bundle

This is the ideal location to begin if you are seeking to enhance your thyroid functionality.

$94.00.

We take pride in providing accessible functional medicine options through our Root memberships, which include downloadable digital meal plans. However, it is unlikely that functional medicine is covered by insurance. In conclusion, we are pleased to offer these services at Root®.

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