Functional and Integrative Medicine: Should You Accept Insurance or Cash?
Why I’m moving to cash pay—and why insurance doesn’t work in functional medicine
If you are a current coaching client or one of my kind followers, you have probably seen my recent messaging about this change: I am officially moving to a cash-pay model. This is not just a business decision—it is about providing healthcare in a way that actually works. And it is time we all stop pretending that insurance is built to support that.
Insurance loves to market itself as value-based care. Sounds great in theory. But in reality, it is just a polished-up way of saying they want providers to do more for less. If it were truly value-based, then experience, clinical judgment, and long-term outcomes would matter. But that’s not what they reimburse.
They do not pay based on how many years I have trained, how many certifications I have earned, or how many patients I have helped avoid unnecessary medications and ER visits. They pay based on arbitrary fee schedules tied to CPT codes that have not kept pace with inflation, let alone complexity. And if they do decide to pay, it is often after multiple rounds of documentation, denials, appeals, and phone calls.
Sometimes we spend more time fighting to get paid than actually doing care.
That fight? It doesn’t come with compensation. There is no CPT code for “argued with insurance for two weeks so you could get your labs covered.” There is no reimbursement for the extra hours we spend researching, coordinating care, or making sure you are not slipping through the cracks. And yet we are told to be efficient, cost-effective, and outcomes-driven—while being micromanaged by a system that undercuts the very care it demands.
You can not call it value-based when you treat providers like liabilities instead of experts.
Functional and integrative medicine just does not fit into that structure. It’s personalized, often complex, and designed to get people off medications or on the right meds—not just juggle them. But that kind of care is not rewarded by insurance. In fact, it is often penalized.
So I am stepping out of it. Because staying in that system would mean cutting corners. And I did not leave traditional models of care and become an entrepreneur just to bring all the dysfunction with me.
This shift to cash pay means I can finally:
Take the time needed to actually treat what’s going on
Order the labs and use the tools that make sense for clients, not for a billing department
Offer a level of support that is proactive, preventative, and responsive—not reactive
It also means I am no longer forced to justify my clients’ care to someone behind a desk whose only job is to protect profit margins.
I know this change will not be the right fit for everyone. I will support those clients however I can if they need to transition. But I can not keep running a practice where I have to beg to be paid for doing high-quality work—and neither should any provider who is serious about real results.
I am building something different. Something sustainable. Something that puts actual care to the center again.
Okay, phew, what a gigantic rant…quick break for a picture of my kids on a recent road trip from Indiana to Texas then please read on.
Doing what we do on most trips we take whether state-side or across the globe-visit museums! Last week was the Texas State History Museum.
Let us talk about whether you can take insurance in a functional medicine practice. In particular I think of functional/integrative psychiatry but the idea can be generalized.
Technically, yes—especially if you are credentialed and already paneled with payers. But here is the catch: just because you can does not mean it is going to work well. You will likely be limited in the labs you can run, the time you can spend, and the interventions you are reimbursed for. You’ll also be stuck with fee schedules that were not designed for holistic care.
Bottom line: if you are doing functional or integrative medicine and want to stay insurance-based, you will need boundaries, workarounds, and probably a thick skin. It can be done—but do not let anyone tell you it is ideal. I promise, you’ll spend a lot of unpaid time doing great work. Clients may not appreciate that effort and insurance companies definitely do not.
And if you are ready to transition out, you are not alone. I am doing it and it was uncomfortable at first. I am still working through some feelings of guilt and such. But it is also the first time in a long time I have felt like I can actually practice the way I was trained to.
Let’s chat in an upcoming post about how you can supplement your income outside of insurance reimbursements.
With Gratitude,
Stacey
