7 Reasons Why Insurance Won’t Pay for Functional Medicine

7 Reasons Why Insurance Won’t Pay for Functional Medicine

7 Reasons Why Insurance Won’t Pay for Functional Medicine

Functional medicine focuses on getting to the root cause of your problem instead of just treating the symptom.

We are living in one of the worst chronic disease epidemics of all time with 1 in 2 Americans living with a chronic disease (CDC, 2017) caused by preventable lifestyle factors, like nutrition and sleep, and a projected 100,000 doctor shortage by 2030 (Association of American Medical Colleges, 2017). 

holistic doctor functional medicine with fruits and vegetables

The solution? If you’re looking to insurance, you may be waiting awhile, at least if you want an option other than the current model, like Functional Medicine or a holistic doctor.

Practitioners who take  an “unconventional approach” to medicine by addressing the roots of disease, as opposed to managing symptoms like the norm.

Sound Familiar?

If you’ve ever been to the doctor, you’ve probably experienced the healthcare rabbit hole. 

  • 1st Step: Feel sick.
  • 2nd: Step Call the doctor to make an appointment.
  • 3rd Step: Wait 1-4 weeks to get seen. 
  • 4th Step: Go to see the doctor. Wait in the waiting room. Chat briefly.
  • 5th Step: Walk out with a prescription or go down a rabbit hole to see another specialist or schedule another appointment.

We ALL know that rabbit hole: 

The Rabbit Hole of Healthcare

In the traditional healthcare system, it takes an average of121 minutes each time a person seeks medical care just to get seen. The total includes 37 minutes of travel time, as well as 87 minutes at the doctor’s office or clinic—most of that spent waiting in the waiting room. (Ray et al, 2015)  

In fact, the average person only spends 15 minutes of “talk time” with the doctor in a visit (Tai-Seale et al, 2007). 

Couple this with the projection tha,t by 2030, America will have a 100,000 doctor shortage (Association of American Medical Colleges, 2017)—unable to meet the “demands” of the, now, 1 in 2 Americans who has a chronic disease (CDC, 2017) and, Houston…we have a problem!

I’ve been there, got the t-shirt. 

The Scene: Healthcare & Current Insurance Inefficiencies 

I had waited 3-months for the appointment with a local doctor in town. 

Nothing unusual—as the “average” wait time to see a doctor nowadays—especially a specialist—is an average of 24-52 days (Merritt Hawkins, 2017). And, not for anything crazy—just an annual “Well Woman” check up. 

So there I was in a conventional outpatient clinic, after 3-months of waiting to see the doctor, and here’s what went down under my conventional health insurance…

What Traditional Health Insurance DOES Cover

1. OVERBOOKED APPOINTMENTS:

Traffic was shut down to one lane on I-35 in Austin and I was running right on time to the appointment (not early). I called the office on my way to inform them of the situation, to which they said to still come in.I managed to park in the lot right at 8:35 a.m. and race upstairs for my 8:30 a.m. appointment.

Once checking in with the staff, she told me she’d have to call back to the doctor’s staff (which they had already done) to verify I could get “in.” 10-minutes later, confirmation was given—I could go back to the waiting room.

2. DISORGANIZATION:

However, before being released to the waiting room, ANOTHER hurdle…

Front Desk: “Oh wait a second..you can’t see the doctor, you have an HMO plan,” the front desk girl said.

Me: “My doctor faxed it over 3-months ago when I made the appointment.”

Front Desk: “You will need to fax it again if you want to keep the appointment,” the girl said.

(I quickly texted my doctor—one of my colleagues and now friends—and the situation was resolved).

3. A SYMPTOM-BASED APPROACH:

As I sat in the waiting room, I was asked to complete a one-page form.The only thing the form asked me about was…my symptoms, my brief health history (surgeries, family diseases), if I smoke or drank, and the date of my last period. 

That’s it.

No exploration around my current diet, sleep habits, what work I had already done around my gut health, my health goals, my physical activity patterns, food intolerances and beyond.

4. CHRONIC DISEASE SYMPTOMS:

Initially, it only took about 15-minutes once I was in the waiting room to go back to the clinic room. The nurse was very nice and did her routine thing: blood pressure, weight check, heart rate and body temperature. She also asked me the SAME questions on my health form. She was shocked to hear how I had NO diseases whatsoever. My ONLY complaint was chronic constipation. (Apparently she was used to hearing ALOT more). 

5. LONG 2-HOUR WAITS:

appointment for functional medicine

After our check in, the nurse left me be…for 2 hours.

At one point in my waiting, she actually asked if she could “pull me” out of my room for “about 10 minutes” to go back to the waiting room in order to see another patient.

So I went back to the waiting room where I waited another 45-minutes…

6. NO APPOINTMENTS: 

I had booked a 10:30 am appointment with a client of mine—allotting for my 8:30 a.m. doctor visit that morning, thinking I’d have plenty of time in between. 10:20 a.m. rolled around and I was STILL in the waiting room. To say the least, I did not get seen, and the nurse told me she’d call back that evening to reschedule…which did not happen.

The Solution?: People Want to Take Their Health Into Their Own Hands

Many people are looking to take their health into their own hands—with at least 80% of all people seeking out advice on search engines like Google alone (Pew Research Center, 2013). 

Others are looking for OTHER options (like holistic doctors, health coaches and functional medicine providers). 

According to a report from the National Institute for Health in 2015 alone, researchers found that about 1 in 3 Americans were utilizing some sort of alternative or holistic care out of mainstream medicine (Stussman et al, 2015). 

Fast forward to today, and there is no doubt that those numbers are consistent—if not more—with the job outlook for all allied healthcare providers expected to go up by 2026 according to the Bureau of Labor Statistics (including occupational therapy, physical therapy, personal fitness training, health coaching, life coaching, acupuncture, chiropractic care and naturopathic or functional medicine). 

However, this doesn’t mean these alternative providers are always covered by health insurance. 

A common question we as functional medicine practitioners are asked is:

Patient: “Do you take insurance?”

Functional Medicine Provider: To which we most often reply, “No.”

Although many holistic doctors and functional medicine practitioners CAN submit superbills, and SOME CAN reimburse partially for visits or lab testing, generally most holistic doctors and functional medicine practitioners are cash pay.

Why?!

Let me give you 7 reasons.

7 Reasons Why Insurance Doesn’t Cover Holistic Doctors & Functional Medicine

1. Insurance is NOT Patient-Centered.

Functional Medicine is patient-centered. Instead of focusing on numbers-centered or about getting more people in the door, wee typically take time to review your chart well before your appointment.

2. Insurance is NOT Big on Taking Time with Patients.

Functional Medicine takes time. We don’t rush to get you through our churn mill. Typically, you will spend 1-2 hours for your first appointment so your practitioner can truly get to know your story. The doctor will assess your health struggles and your goals.

3. Insurance is NOT Focused on the Whole Body.

detoxification pathways functional medicine

Functional Medicine is a “Whole Body Medicine,” taking into consideration all aspects of your health and life. Those that contribute to how you feel and the presentation of disease. It’s different from an endocrinologist who just looks at your hormones and thyroid, an ENT doc who just looks at your ears, nose and throat, or a psychologist who just focuses on your mental health. Functional Medicine acknowledges a respect and awareness of how ALL body systems impact one another, including:

  • Gut Health
  • Brain Function
  • Hormone Health
  • Detoxification Pathways
  • Mindset/Mentality

  • Cardiovascular Health
  • Immunity
  • Thyroid & Metabolic Health
  • Mineral & Vitamin Status

 

4. Insurance Does NOT Address the Roots of Disease.

Functional Medicine does. Instead of looking to suppress or manage symptoms from the top down, we take a “bottom up” approach. We find and address the triggers and root causes of any disease or symptoms a patient is experiencing. These include bacterial overgrowth and SIBO (connected with skin conditions, chronic headaches, metabolic dysfunction, and GI disturbances), or cortisol imbalances (connected with insomnia, anxiety, blood sugar imbalances, and GI disturbances). 

5. Insurance is NOT Focused on Prevention.

Functional Medicine focused on preventing disease, or further decline of health from happening by using laboratory reference ranges (blood work, urine, stool analysis, etc.) that reflect the progression of disease (in order to help reverse it early). We also integrate lifestyle medicine FIRST to support our clients health as a whole. Through a holistic care plan that includes nutrition, supplement, lifestyle healing and stress busting strategies, and physical activity.

6. Insurance Views Functional Medicine as “Quack” Medicine.

Contrary to popular belief, Functional Medicine isn’t about “woo woo” or “voo doo.”  Functional Medicine acknowledges the latest in research to influence and support care. In fact, Functional Medicine is simply an approach to medicine. Healthcare says, “Hey guys, let’s address lifestyle factors FIRST and consider all aspects of health—not symptoms—before turning to medicines or negating other factors of our patients’ modern day lifestyles.

Functional medicine acknowledges science, reason and research for modes of healing and treatment protocols. If anything, is a compliment to the ever-evolving research in traditional medicine.

For example, with the past 3 years of research on the gut microbiome alone (more than 8,000 studies in PubMed), we know that our gut health definitely influences other aspects of our health, including our mood and anxiety levels (Clapp et al, 2017), our metabolism (Boulange et al, 2016) and brain health (Li et al, 2017). In practice, Functional Medicine is more readily able to address gut healing for all types of conditions and diseases.

Another example: when TIME Magazine leaked the “big news” that the sugar industry paid off the FDA to hide evidence that sugar—not saturated fat—was the driver of all disease, Functional Medicine practitioners could further educate their patients as to why butter, bacon and egg yolks are NOT bad. Mainstream medicine on the other hand? Still preaching that saturated fat and high cholesterol are the number one drivers of heart disease. Nevertheless, insurance companies DON’T always look for the research on their own.

7. Insurance is Stuck in the Good Ol’ Days.

If you’ve ever simply tried to call or fax something to your insurance provider, you know the never-ending hold times. In addition, inefficiencies of modern day health care (seemingly stuck in 1961). Whereas, functional medicine is now integrating more and more tele-health, “biohacking” (alternative therapies and healing supports, like infrared saunas, hot-cold therapy, coffee enemas and herbal supplements), and high-tech EMR’s (medical record systems), Insurance still has you on a “brief hold”and is comfortable doing things they’ve always done. 

Bio:

Dr. Lauryn Lax is a Doctor of Occupational Therapy, Nutritional Therapy Practitioner, Functional Medicine Practitioner, author and speaker, with over 20 years of clinical and personal experience specializing in gut health, intuitive eating, disordered eating, anxiety, hormone balance and women’s health. She’s based in Austin, Texas, and operates a virtual Nutrition & Functional Medicine practice, Thrive Wellness & Recovery, LLC, working with clients and patients around the world. In addition, Dr. Lauryn is a published journalist and speaker. Her works have been featured in Oxygen Magazine, Women’s Health, Paleo Magazine, Breaking Muscle, CrossFit Inc, USA Today, ABC and CBS News.  Ultimately, she loves nothing more than helping others “quiet the noise” in the health food and fitness world.

 

By |2019-01-17T03:24:29-05:00January 17th, 2019|Wellness Knowledge|0 Comments

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