The honest answer: it depends
If you've looked into functional medicine, you've probably wondered how you would pay for it. The honest answer is that it depends on two things: the practice you choose and the health plan you have.
Functional medicine looks for the factors behind symptoms like fatigue, brain fog or memory changes, and builds a plan around the whole person. Those visits and lab tests are still medical care. Whether your plan pays for any of it comes down to how the practice bills and what your plan's benefits include.
Why many functional medicine practices are cash-only
Many functional medicine practices don't work with insurance at all. They ask patients to pay out of pocket, sometimes as a membership or a set program. Some give you a receipt you can send to your plan yourself, and some don't. If you're comparing practices, ask up front:
- Do you bill my health insurance, or do I pay you directly?
- Are you in network with my plan?
- Will lab work be sent to a lab that bills my insurance?
A clear answer to these questions helps you avoid surprises later.
How it works at Beckett Ridge Family Medicine
We're an independent family practice in West Chester Township, not a functional medicine clinic. For cognitive decline and a few related conditions, we use a functional medicine–informed approach as part of the care we provide. Here's how billing works at our office:
How billing works
We bill your health insurance for office visits and lab work, including functional medicine care. Coverage depends on your plan, and some tests, treatments or supplements may not be covered. Call us before your visit and we'll help you check your benefits. You are responsible for any charges your plan doesn't cover.
In other words, these visits go through your health insurance the same way a primary care visit does. What your plan pays, and what you owe, depends on your plan's benefits. You can read more on our insurance and billing page.
Questions to ask your insurance company
Before your first visit, call the member services number on the back of your insurance card. These questions can help you understand your benefits:
- Is the practice in network? A plan's network is the group of providers it has a contract with. Ask whether Beckett Ridge Family Medicine and the provider you'll see are in network for your specific plan.
- What are my office visit benefits? Ask what your copay or coinsurance will be for an office visit with a family physician or nurse practitioner.
- What are my lab benefits? Ask whether your plan limits lab work, needs approval ahead of time for certain tests, or uses a specific lab.
- Where am I on my deductible? A deductible is the amount you pay for covered care before your plan starts to pay. Ask what yours is and how much of it you've met this year.
- Are there things my plan won't pay for? Some tests, treatments or supplements may not be included in your plan's benefits. Ask how your plan handles them.
Write down the date, the name of the person you spoke with and a reference number for the call. That makes it easier to follow up if a question comes up later.
What if I don't have insurance?
If you don't have health insurance, or you choose not to use it, you have the right to a Good Faith Estimate of expected charges before your care. Read our Good Faith Estimate notice and call the office to ask for one.
Learn more about our approach
Our functional medicine–informed care covers memory and cognitive health, persistent symptoms after Lyme disease, mold-related illness, long COVID and heavy metal toxicity. Each starts with a careful evaluation and a plan made with you. See our cognitive decline care page to learn more.
Have questions about your benefits before you start? Call Beckett Ridge Family Medicine at (513) 860-4600 and our front desk will help you check your plan.
