Cost, and Why Insurance Does Not Cover It

Usually not, and the reason is structural rather than a judgment on whether the care works.

Why not

Insurance reimburses against diagnosis codes. A code is attached to a visit, and that code determines what is paid.

The patients this kind of practice sees most often do not have a single code. They have fatigue, and weight change, and poor sleep, and gut symptoms, and results within range. There is no code for "several things at once and no diagnosis yet", and the time required to work through it is not reimbursed at anything close to its cost.

The honest arithmetic: reimbursement rates assume appointments of ten to twenty minutes. A practice built on ninety-minute first visits and long follow-ups cannot run on them. So you have a choice between short appointments that are covered and long appointments that are not. There is no version where you get both.

What can still be covered

More than people expect, and worth knowing before you assume the whole thing is out of pocket.

• Standard laboratory testing ordered through conventional labs is frequently covered, depending on your plan and the reason given
• Prescriptions are covered as normal, through your usual pharmacy benefit
• Imaging and referrals to conventional specialists go through the usual route
• HSA and FSA funds can generally be used for consultations, which materially changes the cost for many people
• Superbills may allow you to claim some reimbursement, depending entirely on your plan, with no guarantee

Specialized testing is usually the part that is not covered, which is another reason not to run tests that will not change a decision.

Deciding whether it is worth it

Fair questions to ask yourself, and the answer is sometimes no.

• What have you already spent, in money and appointments, without an answer?
• Is there a conventional route you have not yet exhausted? If so, use it first.
• Do you have a clear diagnosis with an effective treatment? Then this is probably not what you need.
• Can you fund the first few months without strain? If it would be a stretch, say so on the discovery call and ask what the realistic total looks like.