Is Functional Medicine Covered by Insurance?
Healthcare coverage is a common point of discussion these days as costs rise. When it comes to functional medicine, issues regarding costs and coverage remain pain points for many looking to achieve optimal health and make lifestyle changes.
If you're one of the many individuals intrigued by the promise of personalized care and holistic wellness, you've likely asked:
"Does insurance cover functional medicine?"
Here, we will answer this question and more.
Read on to find out whether or not your insurance company will cover functional medicine. We will also address some salient factors behind why some health insurance companies cover certain treatments while others don’t.
Does Health Insurance Cover Functional Medicine? — The Big Question
Health insurance companies can differ in terms of the health coverage they offer their policyholders. However, while health insurance coverage applies to most practices and treatments in conventional medicine, the same is yet to be true for functional medicine.
So, is functional medicine covered by insurance? The short answer is no. In most cases, health insurance policies do not cover functional medicine practices and treatments.
Does this mean you can't use your insurance at all when you walk into a functional medicine practice? Not necessarily.
Read on to find out how your health insurance plan can be useful when you pay for certain integrative and functional medicine treatments, especially functional nutrition.
How Does Insurance Coverage Work?
Understanding how insurance coverage works is essential if you wish to use health insurance or alternative payment methods for functional medicine treatments.
Let’s first revisit how health insurance works. We'll begin with an overview of insurance coverage for traditional medicine treatments.
The Traditional Health Care Coverage Model: What's Covered by Insurance and What's Not
Traditional health insurance begins with a health insurance company. A health insurance company has policyholders to whom they owe coverage. Coverage is usually in the form of the company paying for some or all the medical care costs their policyholders incur.
These health insurance plans typically operate under a model that emphasizes coverage for conventional medical treatments and procedures. By conventional medical treatments and procedures, we're talking about health services and procedures you'd typically find in hospitals or clinics.
While this model has its merits, it often leads to limited coverage for alternative and complementary therapies like functional medicine.
Functional medicine stands out for its emphasis on personalized care and addressing the underlying causes of health issues, which may not align perfectly with the traditional healthcare model. However, licensed nutritionists who practice functional medicine like those at Thrive Nutrition and take certain insurance plans bill insurance for their services which is often completely covered by insurance.
Factors Influencing What's Covered by Insurance
Every insurance company denies or approves coverage based on the following factors.
Insurance Provider Policies: Insurance companies establish policies regarding coverage for healthcare services, including functional medicine. The inclusivity of these policies varies, with some insurance companies offering broader coverage for services and treatments compared to others.
Policy Details and Coverage Options: The specific details outlined in an individual's insurance policy significantly impact coverage for treatments. For this reason, individuals must carefully review their policy documents to understand what services are covered, any limitations that may exist, and alternative payment options available to them.
State Regulations and Mandates: State laws and mandates play a crucial role in shaping insurance coverage for functional medicine. While some states require insurance companies to provide coverage for specific alternative therapies, including functional medicine, the extent of these mandates may vary.
Policyholder Preferences and Choices: Policyholders' preferences and choices also impact insurance coverage. Individuals may opt for insurance plans that offer more comprehensive coverage based on their healthcare needs and preferences. Individuals can also proactively engage with their insurance providers to advocate for expanded coverage options and explore alternative payment arrangements.
Individual Policyholder Factors: Insurance companies can also include and exclude certain coverages based on individual factors. These include age, current health condition, disability status, and other factors that can influence healthcare use.
The Limitations of Coverage for Functional Medicine
Insurance coverage for functional medicine faces several limitations.
Functional Medicine Isn't Reimbursed by Many Health Insurance Companies
One primary challenge is the recognition and reimbursement of functional medicine services by insurance companies. Due to the differences in approach and treatment modalities compared to conventional medicine, functional medicine services may not always be fully covered.
This lack of comprehensive coverage can leave individuals facing significant out-of-pocket expenses when seeking functional medicine care, which can deter many from pursuing this approach to wellness.
The Lack of Recognition by Insurance Companies
Insurance policies frequently exclude or restrict coverage for alternative therapies, including functional medicine.
Even if a functional medicine practitioner is included in an insurance network, the services they provide may not be fully reimbursed. This discrepancy in coverage further complicates the landscape for individuals seeking holistic healthcare solutions.
Variations in State Regulations
Lastly, there's the matter of differences in state regulations. State regulations and mandates can influence insurance coverage, with some states requiring insurers to cover certain alternative therapies. However, these mandates may not always extend to functional medicine services, leaving individuals with limited options depending on their location.
Nutritionists Who Practice Functional Medicine Can Bill Insurance
Licensed nutritionists or registered dieticians who practice Medical Nutrition Therapy (MNT) can contract with insurance companies. Due to the Affordable Care Act, insurers are required cover preventative MNT services like weight loss or those with cardiovascular concerns (high blood pressure for instance) for free. These also often unlimited in number of appointments. Medical conditions can also be covered by insurance but often require a copay or deductible to be met.
How To Use Your Health Insurance for Functional Medicine Practices
It's now clear that health insurance will likely not cover the entirety of your functional medicine therapies or treatments. However, this doesn't mean that you should abandon the use of your existing policy if you prefer the holistic and personalized approach unique to functional medicine.
Although you'll have to pay out of pocket for certain expenses, here are some aspects of the treatment you can use your health insurance on.
1. Consultation
For the most part, the typical health insurance model covers health consultations and says little about the kind of practitioner you go to. Often, insurance plans will cover consultations for assessing health issues or developing treatment plans. The reason for this is that these consultations are deemed essential for addressing patient care needs.
Hence, if your existing policy allows you to get a consultation from any health practitioner, feel free to use your coverage. However, be sure to check your insurance policy closely to avoid disputes with your insurance provider or unnecessary out-of-pocket costs.
2. Lab Tests
Laboratory tests play a crucial role in functional medicine by providing valuable insights into patients' health status, including biomarkers, hormone levels, nutritional deficiencies, and other factors contributing to health issues.
Health insurance plans commonly cover laboratory tests, as they are necessary for diagnosing conditions, monitoring treatment progress, and guiding therapeutic interventions. However, the extent of coverage for specific tests may vary depending on the insurance plan's policies and guidelines.
3. Prescription Medications
Functional medicine is an integrative model of medical care that also incorporates some conventional treatment modalities, including medications.
For this reason, you can use your health insurance on prescribed medications even if you're receiving them as part of a functional medicine treatment plan.
Certain prescription medications prescribed as part of a functional medicine treatment plan may be covered by health insurance, depending on the plan's formulary and coverage policies. These medications may include supplements, herbal remedies, compounded medications, or other pharmaceutical interventions recommended by functional medicine practitioners.
Insurance coverage for prescription medications typically requires adherence to the plan's preferred drug list, formulary tiers, and any applicable co-payments or deductibles.
Important: Check Your Coverage and Eligibility
While consultations, laboratory tests, and prescription medications are commonly covered by health insurance, coverage in functional medicine may vary more widely among insurance plans. Factors such as medical necessity, provider network participation, and plan exclusions can influence the availability and extent of coverage for these services.
For this reason, you should review your insurance policy details, including coverage limits, co-pays, deductibles, and any requirements for pre-authorization. Doing so enables you to understand what functional medicine services and treatments are covered under your current plan.
When in doubt, consulting with your insurance provider can help clarify specific coverage options and explore alternative payment arrangements if necessary.
What If You Can't Use Your Insurance? — Alternatives
When health insurance coverage is either limited or unavailable for your functional medicine treatment, there are alternatives.
Here are some non-insurance alternatives you can take advantage of if your insurance company denies you coverage for functional medicine treatments.
Health Savings Accounts and Flexible Spending Accounts
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) provide individuals with tax-advantaged ways to manage healthcare costs. These accounts allow contributions of pre-tax dollars, which you can use to cover eligible medical expenses. These expenses include functional medicine services like consultations by functional medicine providers, laboratory tests, and prescription medications.
Utilizing HSAs and FSAs can help offset expenses not covered by insurance, making functional medicine more financially accessible.
Payment Plans and Sliding Scale Fees
Many functional medicine practices offer these options to individuals with limited financial resources or insurance coverage. These arrangements allow patients to spread out the cost of treatment over time or pay fees based on their income level.
By providing flexible payment options, practitioners strive to make functional medicine services more inclusive and accessible to a broader range of individuals.
Health Care Membership Plans and Direct Primary Care Models
Some functional medicine doctors operate under these models, providing comprehensive care plans that include consultations, laboratory tests, treatments, and ongoing support.
By subscribing to healthcare membership programs or direct primary care, individuals can receive personalized functional medicine services without relying on traditional insurance coverage.
Healthcare Coverage for Functional Nutrition With Thrive
A big part of the functional medicine model is nutrition. Recognizing this, we at Thrive Nutrition accept health insurance for our functional nutritional services.
From consultations to nutritional plans designed for you, you can use your health insurance to pay for our services. For just a small $20 fee, we can evaluate what your insurance covers so that you can get the best value and lowest out-of-pocket costs on nutritional services. We also provide a handy checklist so you can check your coverage for yourself as well for free.
Here's how we're able to help health-conscious individuals like yourself leverage their policies for our nutritional consultations and services.
In-Network Providers
At Thrive Nutrition, we've partnered with several insurance providers to give you the best access to coverage. Among our in-network partners are Aetna, Medicare, and UHC, with more on the way.
By pairing with the best, we enable you to use your health insurance for the most significant part of functional medicine.
Schedule your free consultation today to learn more about our in-network insurance providers.
Out-of-Network Benefits and Options
For individuals with out-of-network coverage with BCBS, we can still explore reimbursement options that provide a pathway to accessing our services.
We'll assist with reimbursement and streamline the process for your convenience. This way, you get to enjoy the benefits of coverage with the hassle-free process of in-network application.
Learn more about our out-of-network provider options and payment arrangements by scheduling your free consultation today.
Leverage Your Insurance at Thrive Nutrition
The traditional insurance model may fall short when you're seeking coverage for functional and integrative medicine. However, with Thrive Nutrition, you can make your insurance work for you for the biggest part of any functional treatment plan — nutrition.
Schedule your free consultation today and learn more about our insurance-friendly services.