Cost and Insurance
How Much Will My Program Cost?
We understand that the pricing of our wellness program may be a concern, and we'd like to explain it in a way that is relatable and easy to understand. Imagine you're planning to renovate your kitchen, and you invite a general contractor to come to your house and provide a quote.
The contractor will take into consideration your specific needs, desires, and budget before giving you an estimate. Similarly, our wellness program's pricing is tailored to your individual preferences and requirements, ensuring that you have control over the cost.
Think about the renovation process. The general contractor will assess which items you insist on having, such as new cabinets, countertops, or appliances. Some features might be essential to you, while others could be considered luxury upgrades or simply desirable. The contractor will then provide a quote based on your choices, which will ultimately determine the total cost of the renovation.
Our wellness program works in a similar manner. We offer a variety of services and options that can be customized to suit your needs and preferences. You might have specific wellness goals or areas you want to focus on, such as nutrition, fitness, or stress management.
We also offer additional options, such as online courses, functional medicine lab panels, wellness coaching, and group special events, which can enhance your wellness experience but may not be necessary for everyone.
Why Functional Medicine is not Covered by Insurance.
Quite often we are asked if we "accept insurance?"
Let's clarify a few things:
First, this is actually the incorrect wording as we "accept insurance," however the truth is that your insurance won't pay for what we do. The correct question is "Will my insurance cover your services?" and we can pretty much guarantee the answer will be "no" for the following reasons.
Functional Medicine is more of a Holistic Approach: Functional medicine takes a holistic approach, considering the whole person and their environment, rather than focusing solely on a specific disease or condition.
While this approach is very beneficial, there is no universally accepted set of standards or guidelines for the insurance companies to determine what to cover.
Functional Medicine’s Focus is on Prevention: Functional medicine places a strong emphasis on prevention and lifestyle changes, which can be difficult for insurance companies to evaluate and quantify in terms of medical necessity.
While preventative care can ultimately lead to long-term health benefits, it is not considered as essential or urgent to your insurance company like it would consider emergency care with traditional treatments for specific medical conditions. Therefore, insurance companies will not cover the costs as they do not view functional medicine treatments as medically necessary.
The term they are going to use is called "Medical Necessity." When you call, you will need to ask if they consider the services listed in our website tabs "medically necessary."
DEFINITION OF MEDICAL NECESSITY:
"Medically Necessary" or "Medical Necessity" refers to health care services that a health care provider, exercising prudent clinical judgment, would provide to a patient. The service must be:
· For the purpose of evaluating, diagnosing, or treating an illness, injury, disease, or its symptoms
· In accordance with the generally accepted standards of medical practice
· Clinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the patient's illness, injury, or disease
· Not primarily for the convenience of the patient, health care provider, or other physicians or health care providers
· Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or disease
For these purposes, "generally accepted standards of medical practice" means:
· Standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community
· Physician and Health Care Provider Specialty Society recommendations
· The views of physicians and health care providers practicing in relevant clinical areas
· Any other relevant factors
Since we do not practice "medical medicine," nor diagnose or treat, and are primarily performing the services for the convenience of you, the patient, to know the true causes; insurance will not cover our services.
It is essential to understand your insurance plan's is designed to only cover a diagnosis that can be treated in the medical realm and that the patient will be responsible for the cost of their own functional medicine wellness program.
We agree with you that our services should be covered and we do not like this any more than you do. But, we are not in any position to argue with the rules of your insurance carrier.
The pricing of our wellness programs, therefore, is flexible and completely based on your decisions. You have the power to choose the options that align with your goals, budget, and personal preferences.
You can decide which options are essential and which ones are simply desirable, ultimately shaping the overall cost of the program. This allows you to build a wellness program that is both effective and cost-efficient, ensuring you get the most value out of your investment.
Our goal is to provide you with a personalized wellness experience that caters to your unique needs while staying within your budget.