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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.

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