Functional medicine – which prioritizes nutrition – has emerged over the last decade or two as an answer to frustrations many of us feel with “mainstream” medicine.
If you’ve taken your kids (or yourself) to the doctor and come away frustrated or uncertain, or if you’ve had a chronic health problem that your doctor couldn’t fix, then you know why functional medicine is here.
Our health care system squeezes doctors into insurance models that require them to see dozens of patients a week, or even daily. In this model, doctors can only diagnose and treat what health insurers pay for. If your doctor steps outside that model of pre-approved diagnosis codes and treatments, he doesn’t get paid. Ever feel rushed out of an appointment? That’s because the health insurer determines how long your doctor is paid to speak with you for any diagnosis, and what is suitable for treatment.
If your doctor spends time discussing how food, nutrition, or supplements can help you, there is no insurance code for that. Your doctor won’t get paid to investigate that for you or talk with you about it, when they take insurance. These tools work, but are excluded from care because they don’t make profits on the stratospheric scale that patentable drugs do.
Functional medicine doctors step away from this system. They refuse insurance not because they’re greedy, but because they want to direct your care based on their training – not based on what a health insurance claim review person thinks. This frees them to look at you as an individual case, without the punitive system of insurance that may not pay. They can spend as much time with you as they like, and are free to suggest foods, nutrients, herbs or tools besides drugs that can help. They may also use prescription drugs, but will not exclusively use them, as mainstream doctors do.
I used to work for a health insurer. I was astounded to learn that the people who review claims – and decide your fate – may have virtually no training in health sciences. Why would they know more than your doctor, about what is best for you?
The downside of seeing a functional medicine practitioner is out of pocket expense. If you paid your insurance-covered doctor for an hour of his or her time, what do you think it would cost? Hundreds of dollars, perhaps over a thousand dollars, depending on the specialist or nature of the visit. Functional medicine doctors routinely charge as much as attorneys do – $300-$600 hourly or more. You can still submit their invoices to your insurance as long as codes are on them, and some functional medicine doctors will provide coded invoices. You may get some coverage this way. But many families find that a functional medicine perspective is crucial, so they pay for it if possible.
Autism is one diagnosis that leaves children suffering horribly, when functional medicine is left out. Insurers code autism one way – 299.00 is the code for it – and the only services this code triggers are psychiatric. Your insurance will cover psychiatric medications for this code, maybe a brain scan, or perhaps some behavior therapy services, depending on your state laws. If you’re really lucky, you’ll get some speech and language therapy paid for and some occupational therapy. No other treatments for code 299.00 are paid for, period. Nothing relating to the child’s actual physical health is acknowledged. Insurers benefit by keeping autism narrowly categorized as a psychiatric disorder. This way, they don’t have to pay for anything else.
Kids with autism typically have multiple, complex physiological challenges that impact sleep, eating, eliminations, growth pattern, illnesses or allergies, and more. You can take your child to one specialist after another (neurologist, gastroenterologist, allergist, and so on) under your insurance, and each will have their own prescription drugs and procedures. None of these treatments will be coordinated with the others. Your child will be dependent on many drugs and his autism features are not likely to shift much.
A functional medicine approach looks at the whole child. Lab tests to check allergies, immune function, gut function, toxic burden, and neurotransmitter function are usual. These are lab tests that your insurance may only cover if administered by different specialists, or may not cover at all. But they let a functional medicine MD see the whole picture. A care plan is made that allows your child to thrive. Not just be free from illness, but thrive. Development can explode, new language may drop in abruptly, learning may flourish, and your child can begin functioning in ways you never thought possible. Once the brain is freed from inflammation and toxicity, and nutrients flush cells that have lacked them for months or years, big shifts happen. This is functional medicine – it makes you function at your best.
Functional nutrition is the focus of my practice. I’m honored to know and work with Jill Carnahan MD as my authorizing physician on lab testing that I use in my practice, so your child can access many of the same tools with me as are possible with a functional medicine physician – at lower cost for hourly consult fees ($200 instead of $300 and up per hour). Have you added this piece in for your child yet? It can resolve many problems, and lay groundwork for higher level care with a functional medicine physician. It may help your child soar. If your child has had not had success with usual in-network health resources, this may be the charm. Learn more at my blog for topics, strategies, and solutions from functional nutrition, or set up an appointment today. Explore at the Institute For Functional Medicine.
Hello As a parent of 2 children and living in a place here there is no single Functional medicine doctor (Cyprus) I have to take my family health in my hands. All I have is access to internet. My children are small and healthy. Myself however I suffer from 3 autoimmune diseases. I made all necessarily changes based on FM to improve my health and I try to lead my family the best way. I want to avoid for my children having to suffer health issues as myself therefore want to work with preventive way with functional Medicine. My question is what routine FM test should be done as prevention only to children from youngest age.
Hello Marta, good for you for taking charge of your kids’ health! Clinical signs in kids are invaluable, meaning that you may not need much lab testing, which is what functional medicine heavily relies on in practice. But kids are different than adults: The single most important health measure for young children is growth pattern. This is a core descriptor of their health status on so many levels. Everything is downstream of this in kids – and it’s often overlooked by functional medicine providers who have not trained in infant, child, or adolescent nutrition. Your kids should be growing along the same channels in which they were born, generally speaking. So if your baby was a boy born at 8 pounds, which is at roughly the 70th percentile for weight (on the World Health Organization growth chart), he should track near this as he grows into childhood years. If he slides to below the 40th percentile for weight, this would signal a growth impairment that is worth investigating. Likewise if your baby was small after a normal full term pregnancy, and both parents have small stature, then progressing near the bottom of the chart would be normal in that child’s case. Growth impairments have many causes, and there are different types of impairments; I discern and repair these for my clients. If your kids are growing fine, all good – expect that they can generally be well and contented with good color, energy to play and learn, comfortable eliminations daily, robust appetite, infrequent illness and restorative sleep. If any of these things are lacking on a routine basis, investigate. I work remotely via Skype with clients worldwide so if you need guidance, book a slot anytime here.
My daughter has IBS and I was told its a genetic issue causing a longer than normal colon. She eats tons of fibre and does body lengthening exercises like pilates and yoga.
Never heard of a genetic long colon, or an elongated colon causing IBS, but if your daughter feels good with her program then great!
I am looking for referrals for my 14 year old daughter. GI issues began in July. Colonoscopy/endoscopy normal but significant inflammation in stomach. Symptoms: cramping, frequent bowel movements, sometimes diarrhea and touches of blood in stool occasionally although not found in stool sample. Looking for some balance between east and west. Dr is calling it irritable bowel syndrome. She is a devoted vegetarian.
Considering Dr Furhman, Dr Menache or Dr Conti at this point. They are all out of my cigna plan so I can’t visit all and then decide. I am sure you all know people who specialize in this stuff and may be of help. Any suggestions? I am in Scotch Plains,nj
Hi Lisa, I don’t have referring relationships with these MDs so can’t make any specific offerings there. If you’d like support for your daughter’s nutrition component – e.g., food, supplements, gut health, and functional nutrition – that I can do. I work regularly with families via Skype or phone – you don’t have to travel here. Insurance coverage for this kind of nutrition care is rare if not non-existent. I can provide coded statements that show nutrition and GI diagnoses that your insurance may cover, but I don’t bill insurance for families directly. Meanwhile you can ask your local GI for their local insurance-covered nutritionists/dietitians, if you want to go the conventional care route. You might also check the Fearless Parent website as they are based in your region and may have more ideas. FearlessParent.org