A common question that integrative and holistically minded practices are often asked is whether or not functional medicine is covered by insurance. Functional medicine is a style of practice that typically includes extensive testing. See our post about the difference between integrative and functional medicine for an in-depth explanation.
The business model of a functional medicine practice does not integrate well with the conventional insurance model. Functional medicine describes a way of treating dysfunction in the body and finding the underlying cause of disease. Emphasis is placed on knowing the patient and a highly personalized approach. It’s the opposite of the one size fits all, cookie-cutter medicine that is unfortunately very prevalent today in primary care.
By treating the cause of disease, expensive procedures and prescriptions can sometimes be avoided. Functional medicine is a more in-depth look into what is going on with the patient. Visits can be an hour or more and insurance will not cover this type of visit.
The Divide Between the Functional Medicine Approach and Conventional Insurance Model
Occasionally you may find a medical doctor who takes insurance and agrees to run a few tests through some of the functional medicine lab companies, but you’re going to have an awfully hard time finding someone like this. This is because it’s difficult for medical practices to bill insurance for some people and then have other patients pay cash for other things. It creates a mess from an administration standpoint. It also does not seem fair that just because some patients have more money, they get a better workup. However, depending on your insurance, some of the laboratories will make a deal with you. But it can get messy, and you have to be careful that you do not end up paying more than you would if you just paid the doctor at their discounted rate.
In summary, sometimes the lab companies will give you a discount through insurance but very rarely will a visit to a functional medicine doctor be covered by insurance because of the inherent difficulties with integrating a functional medicine approach with the conventional insurance-based practice.