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Can I Use My Health Insurance for Functional Health Coaching?

  • April 3, 2023

You have health insurance and functional health coaching is an investment in a healthier you. So will your health insurance help cover the costs associated? Typically not. In this article, we'll explore why this is the case and why functional health coaching is still more cost-effective for you in the long run.

Unlike conventional medicine, which focuses on treating symptoms, functional medicine and functional health coaching aim to address the root causes of disease and promote long-term health and wellness.

However, one of the most significant barriers to accessing functional medicine and functional health coaching is that they are typically not covered by insurance. This often leads to the perception that these approaches are too expensive, which may deter some people from seeking them out. But, as with many things, the reality is more nuanced than this perception suggests.

Insurance companies and healthcare organizations often impose strict limitations on the amount of time that conventional healthcare providers can spend with their patients. 

However, functional medicine and functional health coaching require a significant amount of time, attention, and effort on the part of the healthcare provider. This includes conducting a thorough medical history, performing advanced laboratory testing, and developing a personalized treatment plan that takes into account the patient's individual needs and goals. By not accepting insurance, healthcare providers can ensure that they have the time and resources necessary to provide this level of care to their clients.

This extra time and personalized care can be difficult to accommodate within the traditional fee-for-service model of conventional healthcare and is one major hurdle to insurance coverage.

The United States currently spends $3.2 trillion on healthcare each year, which amounts to $10,000 for every man, woman, and child in the country. Despite spending more than any other country in the world, the US ranks last overall in measures of healthcare performance among 11 industrialized countries.

Conventional care can be enormously expensive for patients since it relies heavily on medications, surgery, and other expensive procedures. Insurance provides some relief, but it doesn't always cover these expenses, and when that happens, the results can be disastrous.

One in five Americans struggles to pay medical bills yearly, and three in five bankruptcies are due to medical expenses, making healthcare the number one cause of such filings, even ahead of unpaid credit cards or mortgages.

Insurance companies typically only cover conventional medical treatments, like prescriptions, procedures, surgeries, and certain more traditional therapies. This means that services that fall outside of the traditional model of healthcare may not be covered by insurance.

Insurance companies are also incentivized to provide the cheapest possible care, often relying on medications and procedures rather than investing in preventative care. 

However, it's important to note that Functional Health Coaching is not just an alternative form of healthcare. Rather, it's a more comprehensive and personalized approach to healthcare that focuses on addressing the underlying causes of illness, rather than simply treating symptoms, and preventing disease. This requires a different approach than the one-size-fits-all model of conventional medicine.

Functional medicine has the potential to be more cost-effective than conventional medicine over time. While out-of-pocket expenses are currently higher for functional medicine and functional health coaching because of the lack of insurance coverage, clients may have to increase the amount of money they initially invest in their health, understanding that they will receive a significant return over time.

Functional medicine, with its emphasis on preventing and reversing disease rather than just suppressing symptoms with medication, can potentially save patients thousands of dollars over the course of their lives. Functional health coaches work with patients to help them achieve their health goals, whether that means losing weight, improving digestive health, or managing a chronic condition like diabetes or hypothyroidism.

In fact, one study found that patients who received functional medicine care had lower healthcare costs compared to those who received conventional care. The study showed that over a 10-year period, patients who received functional care had an average of 50% lower healthcare costs compared to those who received conventional care. This is because functional medicine focuses on preventing and reversing chronic conditions, rather than just treating them with medications and procedures.

While health coaching is not typically covered by insurance, the investment in a health coach can lead to long-term savings on healthcare costs. For example, patients with type 2 diabetes who receive health coaching are more likely to achieve and maintain better blood sugar control, which can reduce the risk of costly complications like heart disease, kidney disease, and neuropathy. Health coaching can also help patients avoid costly medications or procedures by promoting healthy lifestyle changes.

Functional medicine and functional health coaching also prioritize prevention and lifestyle changes, which can help patients avoid the need for costly medical procedures down the line. This can save patients money in the long run, even if they have to pay out of pocket for these services in the short term.

Most find the investment in functional medicine to be worth it because they receive a high level of care that helps them address problems more effectively and consistently than ever before.

Despite the lack of insurance coverage for functional medicine and functional health coaching, there are still ways to make these approaches more accessible.

  1. Payment Plans - Many functional health coaches, myself included, offer payment plans for patients who cannot afford the full cost of treatment upfront. You can split your investment over three to six months depending on which program you choose.

  2. Group Coaching - You can opt for participating in functional health coaching in an online group setting, rather than one-to-one. This can make your investment more affordable and you can also have the added benefit of experiencing your health journey with a community of like-minded people on the same path.

  3. Health Savings Accounts (HSAs) - You can reach out to your HSA to ask for clarification on what they will cover or reimburse. In my experience, some are willing to cover the functional lab costs and even some supplements. Still, it's best to clarify with your provider before engaging in a program, so you can fully understand your financial commitment.

Until insurance companies see the benefit of not just treating illness but helping people get well, they are unlikely to provide coverage for preventative care. 

In the long run, functional medicine and functional health coaching have the potential to save you money and heartache by helping you overcome your health issues before they become chronic diseases and avoid costly medical procedures, prescriptions, and treatment.

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