Functional Doctors DO Take Insurance!

Finding insurance that covers functional medicine can feel overwhelming, but with the right steps, you can maximize your chances of finding a doctor who takes insurance or advocate for better coverage in the future.

When shopping for a plan, look for these key features:

✔ Medicare Advantage or PPO Plans – These often have more flexibility for functional providers.

✔ Integrative or Holistic Medicine Benefits – Some plans list this under "Wellness" or "Alternative Medicine."

✔ Hospital-Affiliated Functional Medicine Clinics – Large systems like Sutter, Cleveland Clinic, and Stanford may accept insurance for functional medicine.

✔ Coverage for Specialty Labs – Check if your plan covers Real Time Labs and Genova Diagnostics (which offer mold and functional testing).

📌 Action Step: Call insurance before enrolling and ask:

• “Do you cover functional or integrative medicine providers?”
• “Do you cover mold, mycotoxin, or gut health tests through Real Time Labs, Genova, etc.?”
• “Do you cover visits to a hospital-affiliated functional medicine clinic?”
• 
  

If this process feels overwhelming, a licensed insurance broker can do the work for you—at no cost to you!

✔ Brokers have access to multiple plans and can match you with one that covers functional medicine.
✔ They know which plans are best for mold-related care, including those covering functional labs.
✔ They can help you switch plans if your current one doesn't meet your needs.

📌 How to Find a Broker:

• Visit NAHU.org or HealthMarkets.com to search for licensed brokers in your area.
• Ask your local health groups or mold communities if they recommend someone.
• Call and ask: "Can you help me find a plan that covers functional or integrative medicine?"

If you’re stuck with one insurance option, here’s what you can do:

✔ Use an HSA/FSA (Health Savings Account or Flexible Spending Account)

• Many functional doctors accept HSA/FSA payments, so if your job offers one, use it for functional visits & testing!

✔ Ask Your Employer to Offer a Better Plan

• HR departments renew insurance contracts yearly—if enough employees ask for functional medicine coverage, they may add it.
• What to say:
  "A growing number of employees are interested in functional medicine. Can we add a plan that covers it next year?"

✔ Check for Hospital-Based Functional Medicine Clinics

• Some hospital-based programs bill insurance as primary care, making them covered under your plan even if it doesn’t list functional medicine.
• Example: Sutter Health, Cleveland Clinic, or Stanford have functional medicine departments that take insurance.

1️⃣ Call Your Insurance Provider – Ask:

• “Do you have any in-network functional or integrative medicine doctors?”
• “Do you cover visits at [insert major hospital system] functional medicine department?”
• “Do you cover mold or mycotoxin testing at Real Time Labs and Genova?”

2️⃣ Search Online – Visit your insurance provider’s website and look under ‘Find a Doctor’

• Search for: 
  • Functional Medicine
  • Integrative Medicine
  • Holistic Medicine

3️⃣ Reverse-Search: Start with the Doctor, Then Find the Insurance

• Call local functional doctors’ offices and ask:
  “Do you accept insurance? If not, do you know of any functional doctors who do?”
• If you find a doctor you love who does take insurance, ask which insurances they accept.
• Then, use a broker to see if you can switch to a plan that covers that doctor.

💡 This approach flips the search process—find the right doctor first, then match the insurance!

If your insurance does not cover functional medicine, you can push for change!

📞 Call & Request Coverage – Ask your insurer:
✔ “Why don’t you cover functional medicine?”
✔ “Can you submit a coverage request to add functional medicine providers?”
✔ “Other insurers cover functional medicine and specialty labs—why don’t you?”

📨 Submit a Written Request – Many insurance companies track member requests and may add coverage if enough people ask.

🏥 Use the ‘Medical Necessity’ Approach –

• If your doctor recommends functional testing or treatment, get a letter stating it is medically necessary and submit it to insurance.
• Some people have successfully appealed and gotten reimbursement for functional labs & treatments this way.

If your insurance denies coverage for a test, treatment, or doctor visit:

✔ Request a ‘Medical Necessity’ Letter –

• Ask your functional doctor to write why the test/treatment is necessary for your health condition.
• Example: “Patient has chronic inflammation & suspected mold toxicity. Testing is necessary to determine treatment.”

✔ Submit an Appeal –

• Every insurance company has an appeals process (usually found on their website).
• Call & ask how to submit an appeal for denied coverage.

✔ Request a Case Review –

• Some insurers allow external medical reviews if a treatment is denied multiple times.
• This means an independent doctor will review your case instead of the insurance company deciding.

If more people demand functional medicine coverage, insurers will be forced to listen! Here’s how to push for change:

📢 Call Your Insurance Provider & Say:

🗣️ “Functional medicine is the future of healthcare. We need more plans that cover it.”
🗣️ “Many insurance providers already cover functional medicine—why doesn’t ours?”

📨 Write to Your Employer & Insurance Company:
💡 Sample Email:
“I’d love to see our insurance plan include functional medicine. Other major providers like [Sutter Health, Cleveland Clinic] offer coverage. Can we add similar options?”

📣 Encourage Others to Call & Request It Too!
The more people ask for functional medicine coverage, the more likely it is to become standard!

✔ These steps won’t be easy—you will face pushback, gaslighting, and denials.
✔ Insurance companies don’t change overnight, but the more we push, the more they’ll have to listen.
✔ Advocate for yourself, your family, and the next person who gets sick from mold toxicity.

💪 If we stand together and demand change, we will create a future where functional medicine is standard care.

💡 Before You Appeal – Try These First:

Before going through the formal appeal process, use these key phrases when speaking with your insurance provider:

✔ “Can you confirm if functional medicine is covered under my plan? If not, what steps can I take to request coverage?”
✔ “My condition has not improved with conventional treatments. I need access to a functional medicine provider for a more comprehensive approach.”
✔ “Other insurance companies cover this care—can you explain why mine does not?”
✔ “What documentation do you need from my doctor to approve coverage?”

🚀 Denied? Don't Give Up!

Click below to download an insurance appeal template to help fight for your coverage:

📥 Click here to download an appeal template

🛠 Advocacy Matters!

📢 Your voice makes a difference. Insurance companies listen when enough people demand change. If you're denied, consider filing a complaint with your state’s insurance board and encouraging others to do the same. 💪

Together, we can push for functional medicine to be recognized and covered! 🔥