What’s the most common question I get when people visit my website for the first time? The winner, undoubtedly, is: “Do you take insurance?”
The quick answer to that is no, and here’s why.
When I chose to leave conventional medicine to start my functional medicine practice, I did it for many reasons. The constraint I felt from the insurance payment model was one of the big ones.
It’s a bizarre setup if you stop and think about it. During an office visit, the doctor and patient collaborate to decide the appropriate testing and treatment for the patient. Then, the doctor’s office tries to convince the insurance company to pay for it.
Remember that the person deciding on behalf of the insurance company didn’t sit in the room during the visit. The person making the decision didn’t understand the patient’s problem from the start. That person didn’t see the effects of the symptoms on the patient. Instead, that person sits at a desk and decides yes or no based on pre-set criteria.
Frequently, the proposed treatment and testing have to be modified in some way to appease the insurance company and get them to pay for it. Thus, the patient does not receive what the doctor ordered but what the insurance company decides is appropriate.
What is the goal of the insurance company anyway?
Well, it’s a business whose goal is to make money. You or your employer pay a premium. The less money the insurance company pays out to providers, labs, and pharmacies, the more it keeps in its pocket. So, it makes sense for them to say no.
I used to think that maybe it made sense for insurance companies to invest in the long-term health of their patients. Won’t they save more money in the long term by saying YES to treatments that keep their patients healthy?
Honestly, I don’t think so. It’s rare for a patient to stay with the same company for life. We often switch health insurance annually, and by age 65, Medicare kicks in instead of private insurance.
So, oftentimes when the costly effects of chronic disease set in, it’s Medicare’s problem (the government) and not the problem of the insurance company (private sector). Remember, for the entire medical system to work as it is currently laid out, we have to question whether the ultimate goal is even to get people better.
Why I do what I do
I stand firm behind my decision to remove the insurance company from the equation. That frees me up in so many ways. The patient and I can genuinely partner to decide what is best for them.
You wouldn’t believe how much time is spent dealing with the insurance companies in traditional insurance-based offices. My visits with my patients are now 1 hour long instead of 12-15 minutes. The result? I can focus my time and energy on patient care, not coordination with the insurance company.
I tell my patients this: I’m a medical expert, but you are the expert in YOU. So, let’s put our heads together and find the best path forward together—no third party, just you and me. Let’s get you feeling better and optimally healthy. What can be accomplished when everyone is on the same page is incredible.
And if you’re wondering whether insurance will ever cover the costs of functional medicine intervention? The answer is maybe, but probably not in my lifetime. There is hope that we’re headed in that direction, but we still have a long way to go.
Until then, I invite you to be the expert in yourself, feel confident about investing in your health, and trust the process.
