Functional medicine is a growing field that emphasizes personalized care, root-cause analysis, and whole-body wellness. At Avaya Health in Salt Lake City, Dr. Justin Heidemann takes a proactive approach to health that moves beyond simply managing symptoms. But one of the most common questions patients ask before starting care is: Is functional medicine covered by insurance?
The answer depends on several factors, including your insurance plan, the services provided, and whether the provider is in-network. Let’s break it down so you can make an informed decision about your care.
What Is Functional Medicine?
Functional medicine looks at the body as an interconnected system. Rather than focusing on isolated symptoms, practitioners aim to identify and address the root causes of chronic illness. This can include an in-depth review of lifestyle, genetics, nutrition, environment, and mental health. Care often involves longer appointment times, advanced testing, and customized treatment plans involving diet, exercise, supplementation, and stress management.
This personalized approach is powerful—but because it’s different from conventional care models, it doesn’t always fit neatly into insurance company billing systems.
Why Functional Medicine Isn’t Always Covered
Traditional health insurance is designed around short, problem-focused visits and standard treatments. Functional medicine, by contrast, often includes services that fall outside this narrow structure. Appointments are typically longer, testing may go deeper than standard labs, and the care plan may include nutrition counseling, supplement regimens, and lifestyle coaching.
Insurance companies tend to only reimburse for services that are clearly defined as “medically necessary” and part of accepted medical standards. Functional medicine’s individualized, preventative approach is not always categorized this way—so many services go uncovered.
That said, not everything in functional medicine is automatically excluded.
What Might Be Covered
There are parts of functional medicine that may qualify for reimbursement depending on your insurance plan:
- Lab Tests: If your provider orders routine blood panels or diagnostic tests that are commonly used in conventional medicine, those may be covered, especially if there’s a clear medical justification.
- Office Visits: If the provider is in-network or accepts insurance, some standard consultation fees could be partially or fully covered. However, extended or integrative appointments may not be included.
- Out-of-Network Reimbursement: If your provider doesn’t take insurance but offers a superbill, you may be able to submit that to your insurer for partial reimbursement under out-of-network benefits.
- Diagnostic Codes: Some functional medicine services can be billed under traditional diagnostic codes, allowing for potential insurance payment—though this depends on the provider’s billing practices and your insurer’s policies.
Ultimately, coverage varies widely from plan to plan, and it’s important to check your own benefits directly with your insurance company.
Using HSAs and FSAs to Pay for Care
Even if functional medicine services aren’t covered by your insurance, you can often use a Health Savings Account (HSA) or Flexible Spending Account (FSA) to help offset costs.
These tax-advantaged accounts allow you to use pre-tax dollars to pay for qualified medical expenses, which often include:
- Consultations
- Lab tests
- Certain supplements (if prescribed by a medical provider)
- Health-related education or programs
Many patients at Avaya Health use HSAs or FSAs as a flexible way to invest in their long-term wellness without taking on the full financial burden out-of-pocket.
How to Navigate Insurance and Functional Medicine
If you’re considering functional medicine at Avaya Health, here are some steps to help clarify your insurance situation:
- Call Your Insurance Provider
Ask specifically whether functional or integrative medicine services are covered. Inquire about out-of-network reimbursement, deductibles, and coverage for labs or diagnostics. - Ask for a Superbill
Dr. Heidemann’s team can often provide a detailed receipt (superbill) that includes diagnosis codes and services rendered. You can submit this directly to your insurance provider to request reimbursement. - Use a Reimbursement App
There are digital platforms that help you submit insurance claims easily from home. Some even estimate your chances of reimbursement based on your plan. - Explore Payment Plans
Many functional medicine providers offer packages or payment plans to make care more affordable and predictable—even without insurance.
Why Patients Still Choose Functional Medicine
Even when not fully covered, many people feel that the benefits of functional medicine far outweigh the costs. Functional medicine isn’t just about treating illness—it’s about optimizing health, improving energy, preventing chronic disease, and creating long-term wellness.
For patients who’ve tried conventional approaches without success, this model of care offers a deeper level of investigation and support. The personalized nature of the care plan and the time spent with your provider are often viewed as major advantages over standard models.
Final Thoughts
So, is a functional medicine doctor in Salt Lake City covered by insurance? Sometimes—but not always. While some individual services may be reimbursed, full coverage for a comprehensive functional medicine plan is rare under most insurance models.
If you’re considering care with Dr. Justin Heidemann at Avaya Health in Salt Lake City, it’s a good idea to review your insurance options, understand your out-of-pocket responsibilities, and ask about HSA/FSA eligibility.
By taking the time to clarify what’s covered and what’s not, you’ll be better prepared to invest in the kind of healthcare that doesn’t just treat disease—but promotes lasting vitality and wellness.