Using Health Insurance For Chronic Health Conditions

December 19, 2021

Why your health insurance is likely limiting your care options for chronic conditions.
By: Adam Carney
Are you suffering from a chronic health condition or a nagging, mysterious illness?

Most people search for a doctor who takes their insurance in your situation. Initially, this may seem like the logical – or only – route. However, you may be entering the same vicious cycle millions of Americans struggle through.

We hear all the time that healthcare is broken. In truth, that’s is not entirely true. It excels at treating acute illnesses like viral or bacterial infections and anything easily fixed with surgery. That’s what it is designed for.

 

Chronic conditions – conditions like autoimmune, skin conditions, digestive disorders, chronic pain, type 2 diabetes, anxiety, or depression – are where our healthcare system breaks down. It isn’t designed to handle them.

Amongst the 11 high-income countries, the United States ranks LAST in chronic disease healthcare outcomes. Dead last.

“When it comes to managing chronic diseases […] the U.S. health care system is inadequate.” – Marshal Chin, MD, University of Chicago.

If you are searching for help for one of the conditions listed above, you should know you are entering a system that’s fundamentally unfit to help you.

Our medical system is not designed for chronic health conditions.

If you see a doctor for a chronic issue, you’ll likely find yourself in a vicious cycle that looks something like this:

  1. You develop some uncomfortable and persistent symptoms, so you find a doctor who takes your health insurance. You probably have to wait at least two weeks to see your doctor, and they can just barely fit you in.
  2. The doctors see you for 15 minutes in a rushed appointment, ask you where you are experiencing pain, and then write you a prescription without asking about your underlying health.
  3. You can now block some of your pain, but it starts to worsen, and you develop more issues.
  4. You leave more confused, disheartened, and lost than when you began.

Our healthcare system is awful at managing chronic conditions. Doctors don’t even pretend to have solutions and offer medications to dull the pain in most instances.

I’m sure you’ve heard this before; it’s no secret. Yet, millions of people continue to turn to their health insurance and conventional doctors for their chronic conditions because, well, where else is there to turn?

Right now is the crucial moment.

Tragically, millions of people get caught in this cycle and leave their doctor visits disempowered, confused, and alone to deal with their pain. Going through this might make you believe there’s nothing you can do for your pain. If my doctor doesn’t have answers, who would? 

Most people, knowing our healthcare doesn’t help chronic conditions and feeling disempowered by their doctor, still continue to turn back to the broken system because it’s the only thing health insurance will cover.

If you’re reading this, we urgently hope you realize there are solutions for your chronic issues through Functional or Lifestyle Medicine. It’s a different treatment paradigm explicitly designed for chronic conditions. It helps people manage or reverse things conventional care deems “incurable.”

Functional & Lifestyle Medicine: A Real Solution For Chronic Conditions

Chronic conditions never appear out of nowhere. Our habits and lifestyle create chronic disease. And because our habits and lifestyle cause them, they can’t be treated with pills. You’ve got to look at the original causes. Change your habits, change your condition. It is that straightforward.

The moment you open yourself up to changing those underlying health habits, it opens up the possibility for you to genuinely reverse your chronic condition. Doctors like Dean Ornish and Daniel Amen have demonstrated in clinic settings that chronic diseases are indeed reversible through lifestyle interventions and fundamental health shifts.

The idea that chronic diseases are reversible through lifestyle changes is the basis of Functional or Lifestyle Medicine. It’s astonishing how effective it can be.

Functional Medicine doctors don’t just cycle you through appointments and write prescriptions. They run advanced lab tests, give you accurate scientific data on your condition, and educate you with proven ways to reduce your symptoms and manage your condition.

Wisdom (the website you are on now) is a Functional Medicine Clinic with doctors all over the country. Our doctors work outside the broken healthcare system described above and work exclusively with patients with chronic health conditions. We work in a different treatment paradigm designed to help patients reverse their chronic conditions.

  • Our doctors will see you for a full 60 minutes every time, dive deep into your lifestyle, and use advanced testing to identify the root causes of your disease.
  • Our team does things conventional doctors would never dream of, like going to the grocery store with you, doing live zoom educational training, and talking to you about your mental health.

With the industry-wide transition to telemedicine, anyone has access to Functional Medicine treatment.

Functional Medicine not only gives you a real chance to get back to full health but can also save tens or even hundreds of thousands of dollars throughout your life from sunk medical costs.

If the concept of Functional Medicine is new to you, we encourage you to watch some youtube videos by Mark Hyman, or Will Cole,

What About My Insurance? I’m already paying for it…

Health insurance is another aspect of American Medicine that is ill-suited for chronic conditions. America not only has the worst health system for chronic condition treatments, but we also pay more than any country on earth for care. Think about that…

You probably already know health insurance is expensive and frustrating. However, you may not realize how it prevents doctors from giving you the proper treatment. Health insurance companies restrict the type of treatments doctors can offer. Let me explain.

Doctors who accept your insurance can only offer you things your health insurance will cover.

Health insurance policies have a narrow window of the treatments they will cover, typically medications and standard medical procedures. It seldom covers treatments outside these realms. The only way doctors can make money is to write prescriptions and perform routine medical functions.

Studies after studies show that nutrition alone can alter most chronic diseases. Yet, has your doctor ever offered you a nutrition course? Of course not. It’s because health insurance won’t pay for it.

If a doctor wanted to give you training in nutrition, stress relief techniques, or digestive training, insurance would never cover this. So it’s not offered to you.

Think about that for a moment. There may be dozens of treatments available to you that doctors have never suggested, not because they don’t work, but simply because health insurance won’t pay them for it. They must only offer the treatments your insurance will pay for. It’s sad to realize that millions of people like you never get better simply because health insurance gives their doctors the wrong incentives.

However, with all that said, you are not forced to participate in this broken system. When you wake up to this, you can finally start the real work of healing.

Using Insurance for Functional Medicine

Health insurance rarely covers functional or naturopathic medicine, and when it does, it often pays very little to doctors. For this reason, more and more doctors are leaving the realm of health insurance and offering lower-cost care directly to their patients. Many of the best functional medicine doctors leave health insurance to provide treatment programs for patients that genuinely address their conditions rather than the treatments insurance will cover.

At Wisdom, we’ve decided to leave the realm of health insurance so we can offer you the best treatment plans possible, not just the ones offered by insurance. Leaving health insurance has truly revolutionized our practice and allows us to design actual treatment plans for patients, not just what insurance will pay for. We also find it helps save our patients money in the long run on medication and emergency treatments down the line.

After you receive care from one of our Functional Medicine Doctors, we provide you with a Superbill, which you can submit to your health insurance for reimbursement. Often your insurance will reimburse you for a portion of your medical expenses when you submit them a superbill, so you will receive some coverage.

Some Important Insurance And Financial Considerations:

Having a chronic disease is EXPENSIVE. The table below shows the average expenses per year for each chronic health condition.

 

 

 

 

The most important financial consideration here is that cycling through the broken conventional care system will incur you the most costs in the long run. Reducing medical costs is often one of our primary motivators for our patients coming to us.

1. Have you met your deductible?

This is another thing few people realize that makes health insurance even less helpful for chronic disease care.

Your deductible is the amount you have to pay before your health insurance kicks in to help. So if you have a $1,500 deductible, you’ll have to pay all your medical expenses up to $1,500 in that calendar year.

The average deductible for employer-sponsored policies is $1,920, meaning you’ll have to pay $1,920 a year before insurance helps you pay for anything.

That means if you have not yet met your deductible, you’re going to have to pay out-of-pocket for your healthcare anyway. This is just another reason why it makes little sense to use your health insurance system for chronic disease care.

Not sure what your deductible is? Check your insurance card. If it’s not listed on the front of the card, you can call the phone number on the back of the card to find out.

 

2. Should I Change My Insurance Plan If I want to do Functional Medicine?

There are many factors to decide what health insurance plan to be on. More and more people are finding it beneficial to enroll in a major-medical or catastrophic health insurance policy for protection against major health events and then pay out of pocket for routine medical care.

This significantly reduces your monthly health insurance expenses and allows you to start choosing any care you want for your chronic condition care.

3. How much does Functional Medicine Cost?

Typically, our services are significantly more affordable than a traditional doctor.

Unlike most doctors, Wisdom’s doctors don’t charge you for their time. They charge you to design them a real solution to your condition. This is truly revolutionary. Instead of paying per-appointment, not knowing what you’re going to get, your doctor will design you a whole-life protocol that will include:

  • All your doctor’s appointments over three months
  • Advanced lab testing for nutrient levels, hormones, gut-biome, and more.
  • A carefully designed nutritional protocol to help you avoid triggers and eat foods that help you heal.
  • A nutritional supplement or herbal medicine protocol.
  • Bi-weekly appointments with a health coach to help you implement your protocol.

Of course, we can never promise anyone a cure. Chronic conditions can’t be “cured,” but when you learn what triggers them in the first place, you can learn to manage your life so they are no longer present in your life.

Our functional medicine packages start at $1,950 for a 3-month package which can be paid monthly. While we recognize this appears more costly than going to your doctor who takes your health insurance, our health packages give you a real chance to reverse your condition; not just take medication. You’ll save thousands of dollars a year on drugs alone that make this more than worthwhile.

When you sign up for a health package with us, we’ll work with you until you get a handle on your condition. That’s our promise to you as a patient of ours.

Questions About Membership?

One of our advisors can help with all of your membership questions.

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