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Is Functional Medicine Covered by Insurance?

Updated: Dec 19, 2023

Health insurance does not generally cover most functional medicine treatments; however, certain services, procedures, and lab tests in functional medicine can be covered by your insurance, depending on your plan. To understand why insurance does not cover functional medicine, you need to know what functional medicine is.

Functional Medicine vs. Traditional Medicine

Functional medicine is an approach to medical treatment that aims to discover the root cause of a disease and focuses on providing long-term solutions for achieving total body wellness. It is a science-based, patient-centric approach that takes into account a person’s unique genes, biochemistry, mental/emotional factors, and lifestyle. For this reason, practitioners and patients work together to create an individualized treatment plan that addresses them holistically. 

Functional medicine is called “alternative medicine” because it does not apply treatment the same way as traditional medicine. Traditional medicine is more of a disease management industry focused on treating symptoms and prescribing medications. This system of health care relies on labeling a condition with a code and following the procedures and drugs that match. 

Functional medicine is about disease prevention. Traditional medicine is about disease diagnosis.

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Why Isn’t Functional Medicine Covered by Insurance in Most Cases?

The short version is that insurance companies are less interested in preventing disease because preventing and curing a disease can be perceived as a threat to their business. If you’re no longer sick, how can they keep you on the hamster wheel of medication and doctor’s visits that demand your continued insurance payments?

Providing more detail, functional care doctors typically take their time getting to understand their patient’s needs. An initial intake visit could last from one to two hours. That time frame doesn’t work well with the insurance model because insurance companies typically only reimburse physicians for about 15 minutes of the visit. 

In addition, many of the foundational treatments of a functional medicine practice are not accepted under the current standard of medical care. Treatments such as intravenous vitamin supplementation, while research-based, are not declared approved by the U.S. Food and Drug Administration (FDA) or proven by the peer reviews traditional medicine relies on. The traditional medicine standard of care is perpetually 17 years behind the research and shifts in the public consciousness. Without FDA approval, insurance won’t approve it either. 

How Does a Cash Business Model Benefit You?

While it may seem that not being covered by insurance is a disadvantage, it actually benefits patients in a variety of ways.

Advanced Medicine

Being insurance-free allows a functional medicine practice to take advantage of the latest and most advanced therapies and treatments. We are not forced to stick with the outdated medical practices of traditional medicine because that’s all insurance will pay for. 

Personalized Care

That’s not to say that all traditional medical practices are outdated or that medications don’t have their place. On the contrary, functional medicine still utilizes some of these things, but doctors have much more freedom to recommend what’s best for the patient as opposed to what insurance will reimburse. In that way, the cash business model works better for providing patients with personalized health care. 

At our practice, we tailor the treatments to each person’s needs, understanding that while you may have the same condition as another patient, it may not have the same cause. 

Dedicated Time

Because we are not beholden to an insurance company for compensation, we can spend the necessary time to get to know each patient and provide the care they need. That also means we can develop a true relationship with our patients. We partner with you on your health journey, and that cannot be done if we’re rushing each visit to fit a short time allotment.

Pricing Transparency

There are no hidden fees or surprise bills. You won’t have to figure out which treatments or supplies are covered. With a cash-based system, you will always know what’s covered and what you are charged for. Our physicians work with you to determine which tests and treatments are essential and put together a plan that suits your budget and needs. 

Without Insurance, Isn’t Functional Medicine Expensive?

People who seek the help of a functional medicine practice generally don’t weigh the expense as much as the necessity. Patients looking for a drastic and effective change are willing to invest in their health to see that happen. On the whole, receiving the proper treatment for your health concerns is less expensive than continuing to suffer from the same condition, paying for doctors and hospital visits at a standard medical care facility, and getting few health results in return. 

Still, many functional medicine practices will work with a patient to develop a plan that suits their health and budgetary needs. Further, as previously mentioned, some practices do work with insurance to cover certain aspects of the treatment, like lab tests. 

Anti-Aging & Regenerative Associates Uses a Cash + Insurance System

Whether or not functional medicine is covered by insurance, you should put your health first. The medical team at Anti-Aging & Regenerative Associates can provide individualized care that targets your unique health concerns in a way that traditional medicine does not. We use a cash-plus-insurance system to make care more accessible. If you’re ready to make a life change, call us today to learn more about how we can help you. 

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