Functional Medicine is catching on. As more and more Americans realize their daily choices directly impact their health and vitality, we as a culture are seeking health care providers who share this belief and who have tools to help us prevent and reverse disease, not just treat symptoms once they arise. Many want partnerships that educate and empower them. Functional Medicine’s core operating system recognizes the patient as expert in themselves, and believes that our physical bodies exist in a web of interconnections that intimately and intricately affect each other. Just as in nature (roots of trees communicating with each other for the benefit/support of all), OUR nature is to work together.

Unfortunately, our current health care (more accurately, our “sick care”) model is not set up to benefit (read: profit $$$) from this way of practicing medicine. I’m asked almost daily “do you bill my health insurance?” and I totally understand, appreciate and respect this question. We do not. Why? This is a valid question. I remember days of $5 co-pays for my diabetes test strips, $10 office visit co-pays, employer-based insurance that was a great benefit and allowed me ample choice, freedom and access to what I needed at the time. For most of us, those days are gone. Whatever your political beliefs, most of us can agree that health care (sick care) costs have become a financial challenge and major consideration for most people. From my vantage point, after 18 years working in and around health care and 23 years of living with diabetes (one of the most costly conditions – now at epidemic proportions) – the ones profiting most right now are in the insurance business. Doctors and all health care providers are working harder than ever, seeing more and more patients, meeting “productivity” demands and spending more time on their computers than face to face, physical contact with their patients. Patients are spending more money for less coverage, then – even if they call their insurance company to try to be fully informed about the coverage of a visit to this or that provider – they all too often receive a surprise bill in the mail after the fact – a bill of a “co insurance” or notice that they must pay X amount as their deductible must be reached (often exorbitant amounts now, $7000… really??) before this visit can be covered. I’ve received these bills – including one from an ER visit in the middle of the night when my teenage daughter was having terrible, frightening chest pains. I’m still paying off that $1800+ bill – thankfully we found nothing serious wrong – but that bill was essentially to learn nothing serious was wrong! Steep price for peace of mind.

Primary Care doctors are getting particularly squeezed and burdened in this situation. Grinding through 18-20 patients a day – most of whom are coming with needs that require time, attention, intellectual detective work, collaboration and follow up – is a recipe for burnout.

All this – and more – led to our decision to remove ourselves from the rat race of the current system, and create a “Direct Pay” practice. This is, for many people, a new way of thinking about their health care dollars. But it is actually – like Functional Medicine itself – very clear, connected, efficient and empowering.

Do you expect your car insurance to cover the cost of gas, or your oil change, new tires, or 60,000 mile check up? Do you expect your professional insurance to cover the cost of your ongoing education and training? Do you expect travel insurance to actually pay for your travel? Does malpractice insurance pay for a consultation with your attorney? We know from other types of insurance models that the large portion of preventive care and ongoing maintenance is ultimately our responsibility. Our practice operates with this mentality. You need insurance for the catastrophes but can’t rely on it to keep us running optimally.

We have been trained to expect our health insurance to help us be healthy, and truth is, insurance can only partly help us with this. I’ll admit – I am still alive today thanks to injectable insulin which is covered in part by my health insurance. Were it not, the costs would be prohibitive. I use my health insurance to access specialist MDs (with a hefty $200 “co pay”…..), get labs (always those surprise bills after the fact), and have benefitted from surgery, MRIs, ER visits, durable medical equipment and pharmaceuticals-all thanks in large part to my insurance. That said …. These (partially) covered visits are times when I was truly sick. Broke my ankle. Diagnosed with another autoimmune disease. Ongoing type1 diabetes management. Sick care. Get it. Got it. Good. I am so grateful for my insurance coverage.

But Functional Medicine takes time, testing, patience and persistence. It takes an expert provider and a motivated patient coming together with the mutual desire to help restore balance and health to a system that has become dysregulated. A system that has most likely been assaulted on many fronts, via our environment, our food system, our overuse of medications both prescription and over the counter, our traumas, our addictions, our disconnections, our desk jobs…. The chronic disease root-cause approaches are generally not covered by insurance. Dr. Horacek spends on average two hours of in-person time for our first two visits with a new functional medicine client. Two hours! No insurance company is going to reimburse a medical doctor for an intellectual and relational intervention of 2 hours. Then there is the prep and follow up. This is a lot of time. Lawyers charge by the minute of any time they spend related to a client’s case. Doctors have a tremendous amount of unremunerated time spent on client cases. I didn’t realize this until we opened our own clinic, honestly!

Here are some interesting cost comparisons to consider:

Americans spend on average, $1100/year ($3/day) on coffee. (I love coffee. I’m not dissing coffee…just sayin’…)

Americans waste $165 billion annually by tossing away unwanted snacks and meals. The math works out to approximately $529 per person each year.

Americans spend an annual $117 billion on fast food..that’s an average per American (and we know many of you don’t eat fast food) of $347/year…however….Americans collectively spend $1 trillion, or about $3,136 per person, on treatment for sugar-related conditions.

Dog owners spend an average of $140/month ($1680/year) on pet supplies, food, and veterinary care.

The average cable and satellite TV bill was recently around $101, totaling about $1,200 annually.

Cost of an annual Direct Primary Care membership, which includes 4 MD visits (same day/next day as needed), 2 Lifestyle Support visits (nutrition counseling or wellness coaching), management of body composition, functional lab values, nutrient status and more; expert guidance on what changes you can make to optimize your well being (vs trial and error with advice from Dr Google), 24/7 access to your primary care MD if needed, with a personalized, precise approach to YOUR health = $1026. That’s $2.82 per day. Cheaper than coffee and cable tv! J

So the very long-winded answer to this simple Q – Do you take my insurance” – is…No. Caveat? Only if you are a DPC member and have straight Medicare (this is an entirely different conversation – but yes, we DO bill Medicare for our DPC membership).

We believe that our approach is not perfect by any means, and I honestly wish we could take insurance if it made things easier and less expensive for our customers. But for us, this model give us the nimbleness to provide the care to our patients without being beholden to a middleman and employing a full-time insurance billing expert to collect money from the insurance companies. We are part of a large movement of providers going towards such a Direct Primary Care model, choosing to keep the relationship directly between our patients and us.

We are so grateful to our patient community who sees and understands the value of our model and the care we provide, and are always happy to discuss your Qs about how we can help you find an affordable way to create a lasting health solution for your unique body, mind and spirit.