THE ELEPHANT IN THE ROOM…WILL MY INSURANCE PAY?

• Which doctor you can see
• What tests they are willing to pay for
• What procedures they are willing to cover
• What medications they will pay for
• Which types of therapy you are allowed to receive
• How much your premiums and co-insurance will be
• And now you MUST have health insurance!

HEALTH INSURANCE IS NOT HEALTH INSURANCE ANYMORE!

Healthcare costs are the #1 cause of bankruptcy in this country!

And most of these people HAVE HEALTH INSURANCE!!!

Here is the definition of insurance:

“an arrangement by which a company provides a guarantee of compensation for loss, damage, illness or death in return for payment of a premium.”

You are paying your premiums (which increase on regular basis) but where is the “guarantee of compensation”?

Health insurance is not HEALTH INSURANCE anymore…they don’t pay (a guarantee of compensation $$$) for loss of health. They will pay for services in most cases to keep you alive, but they do not pay for services that restore health and wellbeing. It is not health insurance is “disease insurance.”

Here is the health insurance industry’s concept of “health and disease prevention”… run tests to discover if you need a drug! Their idea of prevention is getting you on drugs for cholesterol, blood pressure, diabetes…as soon as possible!

THIS IS WHAT YOUR INSURANCE WILL PAY FOR!!! 

I don’t know about you, but I find this to be really frustrating! I want to help people restore their health, live longer lives and increase their quality of life. Unfortunately, the insurance companies do not share my views on this.

Why will insurance companies pay for drugs but not for dietary supplements?

• This is a controversial issue that is beyond the scope of this blog.  However, I will say that our healthcare system is built on making money for insurance companies and making money for individuals and companies who have a stake in the pharmaceutical industry profits. 

Do health insurance companies get to choose which tests they will pay for?

• Again, insurance companies are in business to make a profit.  They are also in business to support the other stakeholders in the insurance game. Functional medicine testing does not play into the game.  The purpose of functional testing is to identify the root cause of your health concerns.  As a functional medicine provider, I use this testing to help you to restore your health.  I don’t use this testing to put you on medication or set you up for more expensive testing or procedures. A common question I get: Is all food testing paid for by insurance?  Your coverage depends on your plan.  We tell our patients not to EXPECT these or any functional tests to be covered.  Some plans will reimburse for some of the cost, so check with your provider and your specific coverage.

Why do they pay for disease management with drugs but not for healthcare services that could get you off drugs?

• This answer falls in line with the answers provided above.  The most succinct way I can answer this is to say that when you see me, I work for you.  I have a vested interest in helping you reach your health goals.  When you work under your insurance plan, the providers you see work for the insurance company (not you) and are dictated by what your insurance will cover (meaning what the insurance company will pay the provider for).

Why will they pay thousands of dollars in testing if someone has chest pain or chronic headaches but refuse to pay for tests that would – could prevent chest pain and headaches?

• This is also a great question. Our health insurance and healthcare model in general is great for emergency, life threatening health care crises.  This is truly what it is best for and what it is really meant for.  Whether we like it or not, our health insurance is not there to keep us healthy!  That is our job.  And I want to help you to do that.  But I can’t do that under the constraint of a health care system that was not ‘set up’ to do that.  If it was, we would be a much healthier population.  We need a paradigm shift in healthcare and I believe functional medicine is leading the way for us to take back our health!

The plain truth is that our healthcare system is nuts! The system does not make sense, yet we keep trying to make sense of it. We expect it to pay for services that will make us healthy, but in most cases it won’t.

HOW TO PAY FOR A FUNCTIONAL MEDICINE DOCTOR

FUNCTIONAL MEDICINE AND INSURANCE

This takes us back to the original question. “Will my insurance cover functional medicine?” The best answer I can give you is, MAYBE. I would not count on it, but they might. This brings us to another question. Just because health insurance is nuts and may not pay for your treatment, does that mean you should not have it? Don’t get me wrong, I think they should pay for it! But if they won’t, does that mean you should just follow their rules and deprive yourself of wellness and quality of life?

INSURANCE ALTERNATIVES FOR FUNCTIONAL MEDICINE

Some of you may have a Flexible Spending Account (FSA) or a Health Savings Account (HSA).  These are accounts that hold funds for you to use for certain medical expenses that you incur during the year.  These accounts may help you to cover healthcare deductibles and certain other medical expenses. FSA allowable expenses are very specific so check your plan for what you can use your funds for.  Also remember that funds not used in your FSA will be lost if not used by year end (or within an extended time period which may be allowed). 

HEALTH SAVINGS ACCOUNTS – HSA AND FUNCTIONAL MEDICINE

Alternative types of insurance for functional medicine: A Health Savings Account (HSA) is one of the most popular accounts that many patients will use to help pay for functional medicine expenses.  Keep in mind you should always check the details of your plan and be sure to only use it for medical expenses & supplements prescribed by your medical provider.  If you do not have an HSA account, talk to your employer about whether this option is available to you with your health plan.

MEDICARE AND FUNCTIONAL MEDICINE

Unfortunately, Medicare is very limited in providers available and health care costs that will be covered.  Some people think that having Medicare supplement plans will allow for other medical expenses not otherwise covered under the standard Medicare plan.  But the truth is that supplement plans still only cover Medicare allowable medical expenses. 

DO FUNCTIONAL MEDICINE DOCTORS TAKE INSURANCE?

This is a loaded question that implies that we, as functional medicine doctors, choose whether your insurance will pay for our services.  This is a misunderstanding that I want to clear up.  Our goal in functional medicine is to get to the root cause of your health concerns and work with you to restore your health.  Your insurance won’t pay for that kind of care!  If we ‘accepted’ your health insurance, we could not provide the care necessary to do the job YOU want us to do for you!

Will you allow a broken system to dictate the quality of your life?

I don’t let them tell me what to do. If I did, I would not be truly able to help YOU!  Do what is best for my patients…I will do what is best for you!

I will not let some person sitting in a cubicle, with no medical training and who has no idea who you are and what you are going through, decide how your healthcare will be managed.

I am here to serve you, not the insurance companies!

We do not accept health insurance in our office because we are here to do what is best for you and we can’t do that if we are subject to the “rules and restrictions” of the health insurance industry. 

I can’t do what is best for you if they are going to tie my hands. What we do is provide you with the necessary paperwork so you can submit the services to your insurance for possible reimbursement.  I tell my patients not to expect reimbursement but to submit any and all claims so that you may get any benefits that you are entitled to under the healthcare plan you are enrolled in. 

I hope this article has given you a different perspective on health insurance and how it affects doctors who are trying to do what they believe is best for their patients.

Do you live in Frankfort, St. Charles, Wheaton, Chicago or surrounding areas? Are you looking for a functional medicine doctor? Call our office today!

Sometimes people call our office and get upset with us because we don’t accept insurance. We are not singling them out, we don’t accept any health insurance. I love what I do. What I do is help people. I don’t get up and go to work each day so I can fight with insurance companies.

If I wanted to fight regulations, policies, bureaucracy and red tape I would have gone into politics; not healthcare. I won’t let them run my life and prevent me from doing what is best for you.

I’m on your side, not theirs.

It’s your body, your health, your future and your quality of life. 

Do what is best for you and I will too!

Contact my office and speak with our functional medicine consultant.

I wish you health, happiness and a better quality of life!

If you would like more information about functional medicine and integrative medicine or Dr. Borkowski go to napervilleintegratedwellness.com

Do your own research, inform yourself and ask lots of questions. When collecting information, you MUST consider the source. There is no shortage of false, misleading, outdated, profit-driven and utterly biased information in healthcare today; even from the most respected sources and organizations.

This approach to healthcare is not intended to diagnose, treat, cure, mitigate, or prevent any disease. Why? The FDA enforces its position that these words can only be used with drugs. This approach does not use drugs.