This is a question that I get asked often. This is a sensitive subject for most people and rightly so. Most people are spending a good chunk of change for insurance coverage and would like to be able to use it on their treatment of choice. After all, we should have say over our own bodies and be able to choose what treatments are best for us and our family, not what insurance decides is best for us.
What’s covered and not covered by insurance is constantly changing but at the present moment …
IF YOU ARE LOOKING FOR A TRUE FUNCTIONAL MEDICINE PRACTICE WHERE YOUR PRACTITIONER IS PRACTICING IN THE FUNCTIONAL MEDICINE MODEL OF CARE AND NOT AN INSURANCE BASED MODEL OF CARE, THE ANSWER IS LIKELY …. NO.
BUT LET’S DISCUSS WHAT THE DIFFERENCES ARE SO WE ARE ALL ON THE SAME PAGE…
The conventional, insurance based model is based on giving each patient a diagnosis and diagnostic code to match them and then a prescription or treatment to go along with that diagnostic code.
In functional medicine, we are looking at a how the body is connected and considering the matrix of connections and how it ALL is contributing to the disease and symptoms including mental, emotional and spiritual health aspects which makes it hard to put a single diagnostic code or label to each individual. A true functional medicine model is going beyond the single organ system treatment of conventional medicine and viewing the body as one system working together which means addressing many body systems at once – it is all connected. At the core, functional medicine aims to address the why for disease and symptoms. This makes the diagnosis to medication or pill for the ill approach simply not fit.
IN ADDITION…
To get the why of disease or symptom occurrence takes a great deal of time and consideration for each individual. At Wave on Wave Health an initial consult is scheduled for 90 minutes and typically runs over to about 2 hours. Why? As a functional practitioner we want to know the person we are treating – their family, their childhood through present day and identify the antecedents and triggers (things that start the disease process) and mediators (things hanging around that prevent healing) so an effective treatment plan can be put into place. This approach takes a great deal of thought and consideration for each individual before, during and after each appointment.
Functional practitioners will order specialty testing which takes another level of knowledge for interpretation and application of the results. Many of the treatments are considered alternative because we are simply using a pill to treat your symptoms but using lifestyle modification and targeted neutraceuticals to address each persons unique needs to ultimately regain homeostasis in the body.
Functional medicine practitioners know that what works for you might not work for the majority of other individuals because you have a unique genetic makeup, a unique microbiome, a unique history with unique experiences and a unique lifestyle – factors that aren’t considered in mainstream medicine recommendations.
SO FUNCTIONAL MEDICINE IS TYPICALLY NOT COVERED BY INSURANCE,
BUT HERE’S WHY THAT CAN BE A GOOD THING…
Because functional medicine is not covered by insurance, this allows for…
- MORE EFFECTIVE TREATMENT OPTIONS: Because functional medicine is not worried about insurance reimbursement we are focused on getting you better and not working off the standard of care that is out-dated yet covered by insurance.
- PERSONALIZED CARE: Functional providers take into account the uniqueness of each individual – their genetics, their history and experiences, their microbiome and implement treatment plans based on each individual, not what insurance will cover.
- TIME: Insurance reimburses based on the typical 15 minutes visits which are charged anywhere from $150-$400 or more. At Wave on Wave Health our initial consult is 90 minutes because we need to know who you are before we can make recommendations to improve your health. Our followups are also 60 minutes so we can properly assess treatment effectiveness.
- FLEXIBILITY: We can see our patients in office or virtually and we can do visits when we need to not based on insurance recommendations/rules and there are no surprise co-pays.
- TRANSPARENCY: You know the costs of everything. We have an open discussion about lab testing costs and decide together what labs should be done. We also offer much lower, direct pay pricing on many common labs.
- NO BARRIERS: You have access to your practitioners 24/7 and we respond! We also expect to see our patients more frequently in the beginning with this tapering off as homeostasis is returned to the body.
BUT FUNCTIONAL MEDICINE IS EXPENSIVE RIGHT??
We consider this approach an investment over an expense. Our approach will help to get your health back on track and give you the tools to keep it going avoiding further disease and symptom onset in the future.
Functional medicine is NOT more expensive than repeat diagnostic testing and imaging, never-ending workups with no answers (and the frustration that comes with not getting answers), and medications that either don’t work, have significant side effects or come with constant dose changes to treat a symptoms or diseases that could have been prevented.
At Wave on Wave Health we see patients from all walks of life, including those on a fixed budget. Our typical patient is one that has been to many other practitioners/doctors without success at treating their disease or symptoms and is looking for a long-term fix or solution. The investment they make significantly changes the course of their health for the better, improving their quality of life.
I am not saying to get rid of your current insurance. Insurance is something that we need especially for acute medical needs (this is where insurance shines, to be honest). We do try to use insurance coverage for labs, we just always recommend to check on coverage before completing any lab with the alternate, much cheaper, cash pay option available to all of our patients.
We do give our patient’s a superbill for their visit cost that they can submit to their insurance and sometimes we are seeing full or partial reimbursement (this is plan dependent). We do accept HSA/FSA dollars for all of our visits and our neutraceutical recommendations.
Schedule a FREE consult here to find out how we can help get your health back on track for the long-term 🙂
