Why Are Functional Doctors Not Covered by Insurance?

Last Updated: October 2025

TL;DR

Functional medicine is a personalized, in-depth approach to care that focuses on root causes rather than symptom management. Because of the time, testing, and customization involved, most functional medicine practices operate outside traditional insurance models. Insurance typically reimburses brief, diagnosis-based visits, not the comprehensive, lifestyle-oriented care functional medicine provides. At Insight Functional Health in Silver Spring, MD, Dr. Anna Sattah, MD, IFMCP, uses an evidence-based model that prioritizes outcomes and relationship-driven care—without unnecessary costs or procedures.

Key Points

• Insurance plans pay for short, problem-based visits—not 90-minute, whole-person consults.
• Functional medicine relies on preventive, root-cause care, which insurance systems rarely reimburse.
• Testing and time are the main cost drivers; many functional labs are not covered because they’re considered “investigational.”
• Some patients use health savings accounts (HSAs/FSAs) for partial reimbursement.
• Dr. Sattah’s approach is structured for clarity and value: essential testing only, transparent costs, and focused care plans.
• Many patients find that the improved results and reduced long-term medication needs offset the upfront expense.
  

What This Means in Plain English

Most insurance companies are built around conventional medical billing—short appointments, quick diagnoses, and medication management. Functional medicine works differently: it aims to find the why behind your symptoms through detailed history-taking, lifestyle review, and sometimes specialized testing.

Insurance codes don’t usually cover that kind of time or complexity. For instance, a 60-minute root-cause consultation doesn’t fit the 10–15 minute billing model most insurers reimburse. In addition, many of the functional medicine labs that explore hormones, gut health, or inflammation aren’t part of standard insurance networks, so coverage is limited or denied.

That doesn’t mean functional medicine is outside the healthcare system—it just means it operates on a more direct-care model, where transparency and patient involvement come first.

Why Insurance Doesn’t Cover Functional Medicine

1. Time-Based Barriers: Traditional insurance compensates for short visits that follow pre-approved diagnosis codes. Functional medicine visits are longer and more individualized, making standard billing impractical.
   
2. Preventive Focus: Insurance covers disease treatment, not necessarily disease prevention or root-cause analysis.
   
3. Testing Classification: Insurance companies determine that many labs are “not medically indicated” except in cases of advanced disease.  Other functional labs are labeled as “experimental” or “nonstandard,” even if supported by clinical evidence.  
   
4. Administrative Complexity: Submitting functional medicine codes through traditional insurance systems often results in rejections due to misalignment with conventional care models.
   

Because of these barriers, functional practices like Insight Functional Health opt for direct-pay models, which give clinicians the flexibility to spend the necessary time with each patient and to recommend only the tests that truly inform care.

Who This Affects (And Who Still Might Get Coverage)

If you have chronic symptoms, complex conditions, or multi-system issues, you’re most likely to see the benefits of functional medicine—but also most likely to pay out-of-pocket for consults.

However, you might still be able to:

• Use HSA or FSA funds for visits and supplements.
  
• Receive partial coverage for conventional labs ordered through in-network providers.
  
• Request a superbill from your clinic to submit for out-of-network reimbursement.
  

At Insight Functional Health, we help patients understand what’s eligible under their plan and ensure testing decisions are made for clinical value—not insurance approval.

The Insight Functional Health Approach

Dr. Anna Sattah brings the precision of critical care medicine to functional practice—emphasizing safety, efficiency, and value. She avoids unnecessary or redundant testing, prioritizing essential labs that guide decisions. Each plan is tailored to the patient’s goals, budget, and lifestyle.

What makes our model unique:

• Thoughtful testing that answers real clinical questions.
  
• Transparent pricing to reduce cost.
  
• Coordination with your conventional providers when appropriate.
  
• Ongoing follow-ups designed to track measurable progress.
  

This model lets Dr. Sattah focus fully on each patient without the time and billing constraints imposed by insurance-based systems.

When to Seek Care or Clarify Coverage

Seek urgent care immediately if you experience:

• Chest pain, shortness of breath, fainting, or confusion.
  
• Severe abdominal pain, bleeding, or sudden weakness.
  
• Rapidly worsening symptoms that could indicate an emergency.
  

For all non-urgent insurance or coverage questions, our team helps you understand what costs to expect upfront.

Sources

• Institute for Functional Medicine — https://info.ifm.org/
  
• WebMD — https://www.webmd.com/a-to-z-guides/what-is-a-functional-medicine-doctor
  
• Centers for Medicare & Medicaid Services — https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1805B3.pdf
  
• JAMA Network Open — https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753520
  

Medically reviewed by Dr. Anna Sattah, MD, IFMCP
 Insight Functional Health — serving patients in Silver Spring, MD
 Ready to start your functional medicine journey? Book your visit here.
 Learn more about our Functional Medicine approach or explore Cognitive Decline support.
 About Dr. Sattah

This content is for educational purposes only and does not substitute personalized medical advice.