Is Functional Medicine Covered by Insurance?
Part of the Functional Medicine guide
For a broader overview of pricing, see how much functional medicine costs and whether insurance covers it.
My clinic often gets calls asking whether functional medicine is covered by insurance. If you are in a true functional medicine practice, one working in a root-cause model rather than a conventional one, the most likely answer is no, functional medicine is generally not covered by insurance. That does not mean you cannot use your insurance at all, it just depends.
There is no comprehensive functional-medicine insurance plan. Traditional coverage is built around the conventional model, which is oriented toward acute care, diagnosing and treating short-duration illness or trauma like appendicitis or a broken leg. So only the tests, procedures, and services common to that acute model tend to be covered. It is also why most conventional doctors never order the tests we actually need to identify the cause of a health problem. If you want a functional medicine approach that asks why a diagnosis exists in the first place, coverage will usually be limited.
Is functional medicine expensive?
Much of the perception of cost comes from the illusion of our insurance-based, third-party-payer system. Some perspective. Chronic disease is projected to cost the global economy $47 trillion over twenty years and kill twice as many people worldwide as infectious disease. [1] We spend more on healthcare and get less, and the United States has worse outcomes and lower life expectancy than almost every other developed nation. Heart disease, diabetes, cancer, autoimmune disease, digestive disorders, dementia, and more cause endless suffering, and chronic disease now affects one in two Americans and accounts for 80 percent of healthcare costs. [2]
Consider a few examples. Humira, a common drug for autoimmune conditions, costs over $38,000 a year, and its price has doubled since 2012, [3] yet many autoimmune patients can be helped without such expensive immune-suppressing drugs. Or take testing: a comprehensive blood chemistry panel can be billed to insurance at $1,500 to $2,000, and even with good coverage you might pay $100 to $200 out of pocket. The same exact panel, paid privately, runs about $400. And the average annual cost of employer-sponsored PPO coverage for a family of four is now around $26,944, up 86 percent in eleven years. [4] Once you understand the economics, functional medicine starts to look downright affordable, and more effective, than the alternatives.
How functional medicine saves money
As healthcare costs become unsustainable, the core problem is conventional disease management versus functional-medicine prevention and reversal. Rather than finding root causes, patients with chronic conditions are often steered toward costly, lifelong medication and occasional relief. Functional medicine offers the potential for real health restoration and savings by addressing the underlying causes of common conditions, which can free people from dependence on drugs that were never designed to fix the cause.
Functional-medicine practitioners are also not bound by insurance limits on what can be investigated, so they can order the right tests to catch problems before they become full-blown disease. There is typically a 15-to-17-year gap between a scientific discovery and its use in everyday medicine, and functional practitioners close that gap by translating new science into practice much sooner. That combination of scientific rigor and patient-centered pragmatism produces better results in many cases.
How much does it cost to work with Dr. Daniel?
Membership. Dr. Daniel offers an affordable functional medicine membership that includes all lab orders, interpretations, treatment planning, health coaching, and consults for one low monthly fee.
Insurance, HSA, and FSA. The membership does not include lab fees, but insurance, HSA, and FSA accounts are used where appropriate, and in some cases HSA or FSA can cover the membership itself. A comprehensive blood chemistry panel is usually needed to start, and 80 to 100 percent of that panel is often covered. Without insurance, Dr. Daniel contracts with labs for discounted rates, roughly $89 to $400 out of pocket.
Therapeutic order of care. Dr. Daniel follows a therapeutic order, always recommending the least expensive, least invasive option first, with minimal follow-up testing.
Virtual visits. All phone and video visits are included in the membership, and you decide how often you want to meet, at no extra charge.
Treatment. Cost and treatment depend on the person. The team opts for the most minimal effective approach, with the goal of getting you to a point where you no longer need treatment. Care here is consistently less expensive than most functional-medicine practices, because the goal is not to profit from testing or supplements, but to reduce the cost of both.
Your life is your medicine.
If something here rang true for you, the next step is a conversation. Start with a free consult, then we can work on your baseline together.
Reviewed by Dr. Daniel Gonzalez, DC.
