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Why Doesn’t Medical Insurance Pay for Functional Medicine?

By Root Causes Holistic Health and Medicine

Why Doesn’t Medical Insurance Pay for Functional Medicine?What is Functional Medicine?
Functional medicine, also called holistic health and integrative medicine, is a form of health care that makes the health care provider and the patient a tight knit team, built with mutual respect. The goal of the team is to achieve optimal health for the patient using scientifically backed treatment modalities that are effective, natural, and cutting edge. We integrate some pieces of allopathic medicine into the practice of holistic medicine as needed to support optimal health for the patient. However, the cornerstone of functional medicine is the empowerment of the patient to achieve optimal health through nutrition, lifestyle, and natural therapies primarily.

At Root Causes, our goal is to achieve wellness for you by finding the “root cause”, or driving factors of your health issues, and resolve them. Dr. DeStefano contends that many diseases are “fork driven”. Meaning that what you eat or don’t eat is the driving force behind the disorder. Diabetes, hypertension, high cholesterol, some autoimmune disorders, some gut disorders, can be driven by diet, and can be corrected by diet. And don’t forget exercise. Exercise is also very important. Movement keeps a body young, agile and healthy. To nutrition and exercise we can add numerous natural therapies that can help to optimize your health.

Functional medicine is not for everyone or everything. But it is great for a LOT of things. You don’t have to take a pill for every ailment, even though there is one. You twisted your ankle? Instead of an NSAID, try ice and heat, and maybe some red LED light. It works wonders and won’t cause stomach problems! Got an emergency? Go to the hospital! Your functional medicine facility isn’t the place for an emergency. We fully believe in allopathic medical care! We also believe that you can care for yourself in a natural, supportive way. Holistic medicine looks at all aspects of your, and helps you create a healthy body living a healthy life.

My Insurance doesn’t cover that! It must not work…
There are a few timeless questions: What is the meaning of life? Is there a God? What will my insurance cover? Health insurance is a mystery to us all. There are copays, deductibles and premiums. There are doughnut holes! Sometimes a health service will go toward the deductible, but isn’t a covered treatment. It’s totally confusing and we get wrapped up in the insurance coverage game, effectively blinding us to the fact that we don’t need the health insurance companies to keep us healthy.

We don’t need health insurance to be healthy? That’s right! Your health starts with a very simple tool that you have in your home right now. It starts with your fork! Your health is in your hands. You are the master of your body. Taking charge of your health and being healthy isn’t defined by health insurance payment for the service. It is defined by your vitality!

But I’m getting ahead of myself…
Health insurance companies cover different things. I wish I could explain why they cover certain things and not others, but I can’t. I can only tell you that insurance payment is mostly based on the “standard of care” and determination of medical necessity. This is defined (loosely) as the expected treatment for a given condition and the insurance company’s perception of your need for it. For example, the standard of care for elevated cholesterol is to give a statin. That is what is expected. If the practitioners does something else, then it’s not the standard of care. They determine it is not necessary for you, and then it is denied.

Let’s look at a few other examples. Not long ago, chiropractic was considered quackery. Insurance wouldn’t pay for it. But so many people benefited from it, and the discipline grew. The body of chiropractic research grew, it became accepted and, grudgingly, reimbursable by insurance. Acupuncture is at least a 5000 year old practice. It has only recently become recognized as a reimbursable medical service.

Functional Medicine, also called integrative medicine or holistic medicine is a new mode of treatment, much the same as Chinese medicine. It has been around for thousands of years, but it has relatively recently become recognized by the general population as safe and effective, and it is beginning to get a lot of traction. People are beginning to demand integrative, functional, and holistic therapies.

But, functional medicine has two insurance company strikes: 1. It is new to the “medical” world, and 2. Therefore, the therapies are not the standard of care. That does not mean they are not beneficial. They are VERY beneficial, they just aren’t covered by insurance.

Take charge of your health! Call Root Causes and let us guide you to optimal health!

Dr. DeStefano, of Root Causes Holistic Health & Medicine in Ft Myers, FL, incorporates IV & Chelation therapy with hyperbaric chamber sessions to combat multiple chronic conditions and disease states. The methods Dr. DeStefano uses to rectify gut inflammation, as well as the inflammatory response throughout the entire body is multifocal. She listens to her patients well, and works out specific protocols for their unique issues.

Doreen DeStefano, NHD, BSN, RN
Dr. Doreen DeStefano holds a doctorate in natural health, an MPA in public business, MS (ABT) in criminal psychology, and a BS in exercise physiology and nursing. She previously held an EMT certification. Dr. DeStefano has been practicing in natural health for over ten years. Her area of interest is healthy aging and prevention and resolution of chronic symptoms associated with aging. She believes that growing old should not mean breaking down.

Root Causes Holistic Health and Medicine
12734 Kenwood Lane, Ft. Myers, FL 33907

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