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Are Functional Medicine Doctors Covered by Insurance?

Your Insurance isn’t about Health

Healthcare in America has been turned inside out in the past 10 years, and even more in the past 3 years. Your deductibles have skyrocketed, $2000 to even $10,000, when just a decade ago, less than $1000 was common.

Your premiums have also gone through the roof! Doubled and tripled year after year, especially if you are self-insured. And your copays are almost as much as the visit!

Many of your favorite doctors are no longer in your plan, so you change doctors or pay out of your own pocket. Are your doctors really keeping you healthy, or just keeping you from dying?

Couple those facts with the time constraints on your doctor, 3-8 minutes per patient and it is a lose:lose situation.

So you look for something else, but, are functional medicine doctors covered by insurance?

Let’s dig into the subject a little. Yes, a highly emotional subject – I know. Hang with me here. I do not want to start a healthcare debate on my blog. I just want to touch on a couple of points.

  1. What is YOUR personal health vs disease philosophy?
  2. Who’s responsibility is it to take care of YOUR body?
  3. What does medicine look like in the future?
  4. What is insurance for in the first place?

DISCLAIMER! If this is a highly charged subject for you, I do not want to add stress to your life. I am not opposed to our traditional medicine or insurance as a concept, at all.  On the contrary. I think our medical doctors are the best trained ACUTE and emergency physicians in the world. I think in the terms of joint replacement and plastic surgery, we probably rank top in the world. There are some amazing and awesome docs out there!  I am blessed to know quite a few.

I have always said, if you are having a heart attack, or get your arm cut off by the bus that hit you, don’t call me. I will help you heal once the crisis has passed.

I think that a system we pay into for future healthcare needs or emergencies is great and is part of being a self responsible citizen. I am NOT going to debate WHO should write the checks – insurance companies or the government  – because I don’t really want either entity dictating how MY money is spent for MY healthcare.

So let’s take this in a different direction…

What is your Personal Health vs Disease Philosophy?

Functional Medicine Screening

 

  1. Doctors are 100% responsible for my health. I expect them to know what is happening in my body if I have symptoms and they should know how to treat it with pharmaceuticals to fix the problem.
  2. Doctors are 50% responsible for my health. They should know when to use a medication and when they should put the responsibility in my lap.
  3. I am 100% responsible for my health.  My doctor should serve as an educational point of contact and have the knowledge base to recognize whether a pharmaceutical answer or a lifestyle answer is best for me. They should also be able to point me in the direction of that lifestyle shift with specific recommendations, and understands the use of Pharma, if necessary, in combination with lifestyle changes and supplements.

These percentages are clearly arbitrary to make a point.

Self Responsibility

  1. If you are in the first camp, our traditional medicine system is set up for you.  You can go to your primary care physician and get your symptoms handled by Pharma, and worry no further.
  2. I am not here to convince you otherwise. Your insurance should pay just fine, because you fit the profile. You wait to get an illness and the doctors will do their best to keep you comfortable.
  3. If you are concerned about taking medications you would probably fit best in the second category.  You would like to use Pharma, if necessary, and are dubious but somewhat intrigued by alternative care. You are relying on your traditionally trained doc to tell you what is best for you.

Again, I am not here to convince you otherwise.

Just one question, if your traditionally trained doctor has never had a class in nutrition, exercise physiology, or any other lifestyle component, how would they know to offer you anything other than Pharma Solutions?

 

Are medical doctors trained in nutrition?

Delicious Salad on Table

 

Only about 25% of Medical Schools offer any training in Nutrition TODAY!

Yet, 90% of the healthcare crisis is firmly planted in lifestyle issues.

  •  Over 70% of Americans are overweight and obese
  •  Type 2 Diabetes, obesity, heart disease, stroke and high blood pressure is 90%lifestyle driven
  •  Type 2 Diabetes, heart disease, and high blood pressure are responsible for 90% of our healthcare dollars

So let me repeat: Only 25% of Medical Schools offer training in Nutrition and lifestyle. Our doctors are clearly NOT trained to handle the chronic diseases of our country.

Let’s get back to insurance, then we will address the third category.

Should my insurance cover Functional Medicine?

Insurance Coverage for Functional Medicine

 

Look at your auto, home or renters insurance. When does it pay? Does it pay for new tires on your car? New windows or paint for your home? NO! It pays when something goes wrong.

This is the same philosophy of health insurance. It pays when something goes drastically wrong. Not for neglected maintenance.  If you neglect to change the oil in your car or paint your house and either start to fall apart, who’s responsibility is it?

So, when you have neglected your body for years, like putting in crappy oil, gas and sub-par transmission fluid in your car, UMMM can you say the Standard American or Modern Urban Diet (SAD MUD)? Should your health insurance be responsible for picking up the tab for you to find your health again?

Sorry, no!

What does my insurance pay for?

  1. If you have that massive heart attack, need high blood pressure meds or anti-diabetes drugs while you change your lifestyle, your insurance will pay.
  2. But, to think your insurance should pay for you to go to the gym, to pay for tests that ferret out deficiencies or Food Sensitivities is no different than expecting your auto insurance to pay for oil changes.

Would it make more sense for insurance to pay for these things? ABSOLUTELY! Does it really make me want to burst into an all out passionate, soapbox rant – more than I already have?

ABSOLUTELY!

  • Unfortunately Big Insurance, and Pharma, along with our medical schools have set up a system that has nothing to do with actual “HEALTH” and everything to do with “SICK”.
  • This system is setup to keep you from dying. It is not concerned about you living a vital, productive, happy life. Nor are they concerned with the day to day quality of life, until the end.

I’m sure that feels a little “in your face”. It is…and it’s truth. Yes, you will find some great doctors, I have already said that. I am speaking about the majority.

Functional Medicine—a new approach to healthcare

Functional Medicine's New Path to Health

 

The third category of Health Philosophy – I am 100% responsible for my health.  My doctor should serve as an educational point of contact and have the knowledge base…describes the Functional Medicine Doctor.

  • We take a proactive approach. We think – Let’s NOT neglect the maintenance.  And if you have neglected it in the past, let’s do our best to keep our original body parts by carefully restoring our body to normal function as much and as quickly as possible.  
  • We generally spend way more time with you. Many spend up to 2 hours for an initial visit and 10-30 minutes on follow-ups. Does this sound like anything that would be covered by insurance at this time?

Unfortunately, no. I believe this needs to be the medicine of the future.

You Need a TEAM!

The idea being to work together, as a team for YOU, the patient, towards a healthier lifestyle with whole, real food, movement, healthy relationships.  Not processed junk – SAD MUD! And stress! Yes, there are actually four entire industries that needs to shift – Food processing, Insurance, Pharma and Medical education.

This could take more than 50 years for that to happen. This is a blog for another day.

Think about it, if all the medical schools were to add nutrition training today, it takes 10-15 years to finish school, and there are only about 20,000 graduates a year.  Right now there are about 700,000 medical doctors in the US.

Do the math. It will take 15 years for the first 20,000 to graduate, and 30 more years before we would have any significant number of doctors who know about lifestyle, diet, exercise etc.

Frankly, our medical system is already overrun by the shear number of cases of diabetes, heart disease, stroke, high blood pressure and now a huge rise in autoimmune disorders.  

There aren’t enough meds or doctors to handle the effects of the SAD MUD lifestyle epidemic.

Conclusion

So let’s finish the insurance issue.

You probably have a good idea why many Functional Medicine doctors don’t take insurance. The good news is, depending on your plan, some of your labs may be covered, some of the office visits may be covered. Honestly, best not to count on it.  

Insurances are cracking down on paying for “maintenance care”, regardless of medical necessity.

Yes, Yes, Yes!!! It doesn’t make sense and leads to much head banging…but that is the way the system is set up for now.  There are many ways to handle the expense. Many Functional Medicine Doctors are set up as a monthly membership, some take CareCredit or similar healthcare credit cards, most take Visa, MasterCard, and for some of you, your Health Spending Account (HSA) or Flexible Spending Account (FSA) may pay for their services.

 

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