Many people who have contacted our office for our services have asked us why we charge a membership fee. We fully understand the financial challenge this presents to some patients, and we wish there were a way for us to bill your insurance company for all services provided during your Integrative and Functional Medicine evaluation. Unfortunately, at this time, there is not. Here is why:
1. Health insurance companies and Medicare only allow for a limited amount of allowed or covered procedures and medical care.
In general insurance companies are not focused on wellness or preventative health care. Neither are they focused on keeping up with the most recent and applicable scientific advances. There may be a limited set of covered services but they are restrictive and do not take into account the most up-to-date clinical research and evidence. In general, it takes 15–20 years for clinical research to become the ‘standard of care’ and for some advances it can take longer (handwashing in the mid 1800’s took decades until it was fully accepted throughout Europe). Providing the most up-to-date and relevant care is what Integrative and Functional Medicine is all about. The insurance industry is heavily invested in the conventional model of health care that too often relies on drugs and surgery. We are committed to the functional medicine model that addresses the underlying causes of your symptoms with specific nutritional and lifestyle recommendations and applies the most recent advances in scientific discovery and care delivery.
2. Insurance company’s reimbursements only cover accepted diagnoses as determined by the ICD-10 coding and diagnosing system.
Any illness outside of this system or any time required that is over and above the allowed time is not reimbursable. In general, these established fees cover the actual cost of the briefest (and we believe the lowest quality) care. At the same time, the participating provider’s office overhead costs have increased dramatically because of the staff, time, and equipment necessary for processing and tracking claims. In today’s healthcare environment, the actual cost for doctors to provide services continues to rise, while the percentage of reasonable fees that insurance payments cover is declining. Most doctors and clinics cope with the requirements of being participating providers by keeping their office visits brief so that they can see many patients within a given timeframe. When their clinic becomes unprofitable, it must be supported by another institution. Many primary care medical clinics are not self-sustaining financially and have had to merge with hospitals whose expensive, high-tech surgical and diagnostic procedures are priced to keep the clinics afloat financially.
3. Finally, Integrative Medicine and Functional Medicine are not presently recognized by the insurance industry.
Integrative Medicine is a board specialty recognized by the American Board of Physician Specialties and Functional Medicine is currently being practiced at over twelve university hospitals and there are multiple integrative residency programs. Some of these include the Cleveland Clinic Center for Functional Medicine, The George Washington Center for Integrative Medicine and The Arizona Center for Integrative Medicine. Despite these facts, many services provided under these specialties are not reimbursable.
