Over the past several decades, using insurance to pay for medical care has become the norm. It is so common that most people don’t think of their medical care and their insurance as separate things.
Having health insurance is an important part of being able to access medical care that would otherwise be prohibitively expensive. But is using your health insurance always the best option for getting the care you want? Let’s take a closer look.
How insurance works
Health insurance has been (and still is) offered in many different arrangements: HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), and high-deductible health plans are some of the most common. They are a little different in how they are structured and how much they cost you (both your monthly payment and your per-visit coinsurance).
One thing that all plans have in common is that your employer (or whoever provides your insurance) has negotiated with health insurance providers on the “benefits” you will receive. Further, there are contracts between health insurance providers and health systems (hospitals, clinics, pharmacies) for the prices they will be paid for the services they provide.
What does this mean to you? In a nutshell, it means you don’t have much choice in the care you’ll receive. You will need to go to a certain group of doctors for care, or to a certain hospital for testing. If you’re lucky enough to have some choice in the matter (often the case with PPOs), it is likely going to come with a much higher price tag.
Most of us have been on the receiving end of this triangulated care situation: we have to switch doctors because ours is no longer on “our plan” or, our doctor wants us to have a test or medication, and the insurance company denies it. Unfortunately, this is not the only constraint health insurance has on our care.
Why insurance doesn’t always work well
One of the most significant impacts that health insurance has had on our medical care is that it has created a model where doctors need to see as many patients per day as possible. This means visits are often brief, superficial, and even sometimes dismissive. Doctors can still be incredibly caring, but be stuck between a rock and a hard place with respect to the time they can spend with you. Unfortunately, this doesn’t work well for many of us who want to have options for our care, have a deeper relationship with our doctors, and receive personalized treatments for our health.
For this reason, many functional medicine doctors charge their fees directly to the patient. In most cases, severing their ties with insurance companies allows functional medicine physicians to charge less yet spend more time with their patients–a win-win.
While many doctors have opted out of health insurance contracting, there are functional medicine doctors who take insurance. You may be able to find them on reputable functional medicine websites like The Institute for Functional Medicine.
Using “out-of-network” plans
Some insurance companies will reimburse for medical care with providers, clinics, and health systems that they aren’t directly contracted with. This is called “out-of-network” benefits. Most functional medicine practices, including Vytal Health, will provide you with the necessary insurance codes and paperwork to submit to your insurance to consider repaying you for your out-of-pocket expense to your functional medicine doctor. While there is no guarantee that your insurance will reimburse you, it is worth considering. Keep in mind that if you have a high-deductible health plan, your “out-of-network” plan will often have a separate deductible to meet.
What about HSA/FSA plans?
HSA (Health Savings Accounts) and FSA (Flexible Spending Accounts) are available to some people who have a high-deductible plan. In these accounts, pre-tax dollars are placed directly into an account for you to use as you choose for your medical care.
There are certain rules and regulations about what you can spend this money on (consult your health insurance’s guide or check the rules online), but for the most part, doctor visits are allowed. Lab tests, certain medications, and even supplements can also potentially be covered.
Many functional medicine practices, like Vytal Health, encourage you to use your HSA or FSA dollars to pay for your care, if it is available to you. It can be a simple way for you to receive the kind of care you are seeking.
What should I use my insurance for?
Even though your functional medicine care may not be covered by your insurance, many other aspects of your care with a functional medicine doctor are.
Having blood work done at a lab is often covered by insurance, as are x-rays and other radiology tests, like CT scans or MRI tests. Seeing a specialist or going to urgent care are also typically covered. We recommend you make sure you understand your deductible so that you aren’t surprised by a high medical bill for something you thought would be covered by your insurance. Unfortunately, the health system, clinics, and other traditional health care providers aren’t great at letting us know the prices of tests and medical visits up front. This lack of transparency causes a lot of stress. Vytal Health, and other functional medicine practices, give all of their prices up front, which helps you understand exactly how much you will be paying for your care, putting you back in control.
Even though we’ve discussed many negative aspects of health insurance, having good coverage for unexpected illnesses is very important to protect your financial well-being. A catastrophic health problem can cause thousands, sometimes hundreds of thousands of dollars or more. For this reason, we recommend that you have health insurance to protect you.
The bottom line is that insurance is important, but so is getting the care you want and deserve. If your doctor decided to study functional medicine, it is often because she wants exactly what you do: the time to understand you, the tools to help you, and the approaches you value. Until the insurance world catches up, thankfully practices like Vytal Health are available to meet your needs.