Insurance and Cash Prices

Does Insurance Cover Functional Medicine?

“Does insurance cover functional medicine?” This is one of the most frequently asked questions Dr. Lukaczer’s functional medicine practice gets from new patients. New patients are also curious about what functional medicines services are covered and whether there are options for individuals who don’t have insurance.

The answer is complicated – some insurance providers cover functional medicine, while others do not. And some functional medicine practices don’t accept insurance at all, so it doesn’t matter if your insurance covers functional medicine. So check what is covered before signing up for any outside functional medicine or alternative treatments.

In short, Dr. Lukaczer accepts many common insurance plans. Keep reading to learn more about which plans are accepted.

Does Dr. Lukaczer Take Insurance that Covers Functional Medicine? Yes!

Dr. Lukaczer’s office accepts a wide range of insurance plans including Regence Blue Shield, Premera BlueCross, Lifewise of Washington, most out-of-state Blue Cross/Blue Shield plans, FirstChoice Health Network, and Kaiser Permanente of Washington PPO plans.

We’re not currently contracted with Cigna, United Healthcare, Kaiser HMO plans, or Aetna. However, you may have out-of-network benefits that cover some of your costs per your specific plan. Call your provider to verify your insurance does cover functional medicine prior to making your appointment. Payment is due at the time of service.

Can I Pay Cash? What Are Your Prices?

If you do not have insurance or your insurance does not cover naturopathic medicine, my rates are below:

  • $250 for a new patient appointment (90-minutes)
  • $200 for follow-up appointments (60-minutes)
  • $135 for follow-up appointments (30-minutes)

A 20% discount off the above cash prices is available for military and Medicaid patients. Payment is due at the time of service via credit card.

Does Insurance Cover Shared Medical Appointments?

Yes, shared medical appointments (SMAs) are often covered by insurance. You might not be familiar with this term, but insurance companies use SMA to refer to medical appointments hosted in a group setting. SMAs are hosted regularly by Dr. Lukaczer and select partners. Click here to learn more about these group sessions.

Can I submit my lab fees to insurance for reimbursement?

You have the option to bill any conventional lab fees directly to your insurance. Just provide the lab with your insurance information. If your insurance plan covers lab expenses, this can help offset the costs. However, if your insurance does not cover lab tests, your deductible is too high, or you don’t have insurance, we also offer special discounted cash rates. These rates are significantly lower than the out-of-pocket costs you would incur by paying the labs directly.

Do You Accept Medicare or Medicaid?

Unfortunately, functional medicine doctors are not able to bill Medicare or Medicaid for services. If Medicare is your primary coverage provider, you might choose to work with an in-network provider for your primary healthcare needs while seeking functional integrative medicine consultations periodically. In some cases, labs may be billed to Medicare, although coverage may vary. If you prefer to pay out of pocket, we have negotiated discounted cash prices with specific laboratories. Additionally, for those on Medicaid, I offer a 20% discount on services.

Can I use my Health Savings Account (HSA)?

Certainly! You can utilize your Health Savings Account to cover functional medicine services. This allows you to use pre-tax dollars to pay for your healthcare expenses. For more information, please contact your HSA broker or provider.

If you have any questions about functional medicine or need to make an appointment, get in touch with Dr. Lukaczer’s office today.

3 Reasons Why a Functional Medicine Practice Might Not Participate in Traditional Insurance Plans

1. Insurance Prioritizes Pay-Per-Service

Insurance reimbursement for functional medicine services may be limited or nonexistent since insurance billing often does not align with the comprehensive and individualized nature of functional medicine. At a hospital, doctors bill by the service, glove, scan, and pill. Functional medicine treatment plans don’t always lend themselves to itemized receipts that are necessary for insurance.

2. Insurance Focuses on Medical Necessity Over Personalization

Functional medicine practitioners invest significant time and resources into thorough evaluations, in-depth consultations, and specialized testing, which may not be fully covered or reimbursed by insurance. Insurance companies might push back and say that an hour-long consultation isn’t necessary.

3. Functional Medicine Practices Want Autonomy

By operating outside of insurance-based models, functional medicine practitioners can maintain autonomy in their treatment decisions, prioritize longer appointment times, and offer more personalized care that addresses the unique needs of each patient. This approach allows for greater flexibility and a focus on optimizing health outcomes rather than adhering to insurance-driven protocols.

These are just a few of the reasons why some functional medicine practices don’t accept insurance. However, Dr. Lukaczer does accept many common insurances. If you still have questions, please give our office a call.