Many people ask me, “Will I get reimbursed when seeing a functional medicine provider?” It’s a great question—and not surprising, given how complicated insurance can be (often by design). The short answer: Yes, reimbursement is possible, but it depends on your insurance plan. At Tendwell, we provide a document called a “superbill” for each visit to make the process as straightforward as possible.
How Reimbursement Works
A superbill is an insurance-industry document that provides information on the care you received and the cost you paid. Insurance companies use the information to determine your coverage. Our superbills include:
Your payment details: The cost of your visit, based on the fee for your package or membership.
Standard diagnosis and visit codes: We use ICD-10 diagnosis codes and CPT (E&M) visit codes that align with conventional medical billing practices.
Your job is to understand your insurance coverage and to submit our superbills to your insurance company. If all goes well, you will receive a check from your insurance company reimbursing you for a portion of our fees.
My Insurance Does Not Cover “Preventative” Care . . . Does That Mean I am out of Luck?
Functional medicine doctors focus on root causes, so, in a sense, our care is “preventative,” but not necessarily in the same sense that your insurance company uses the term. When you receive services from Tendwell, our superbills reflect codes for the treatment of symptoms, which are not necessarily deemed “preventative” in the insurance industry. Most patients we see have symptoms like fatigue, heartburn, abdominal bloating, hypothyroidism, IBS, menopausal symptoms, and more. Although these are common concerns, the codes help bridge the gap between functional and conventional care when submitting claims.
What to Ask Your Insurance Company
To understand your coverage, ask your insurer the following:
Do I have out-of-network (OON) benefits?
Is there a deductible I need to meet before my OON benefits apply?
How much is that deductible?
These details are critical for determining what portion of your visit costs might be reimbursed.
Additional Tips to Keep in Mind
Lab Work: At Tendwell, we partner with Labcorp and Quest for lab testing. While we are out-of-network, these labs can bill directly to your insurance for tests they cover. It’s always a good idea to check with your insurer beforehand to confirm whether a specific test will be reimbursed.
Why Labcorp? I prefer Labcorp because they provide an upfront estimate of patient costs before drawing blood. This transparency helps you plan financially and avoid surprises.
How Tendwell Supports You
To make reimbursement easier, we provide:
Access to the Reimbursify app: This app simplifies the process of submitting superbills (your medical receipts for paid services) to your insurance company.
Traditional submission options: If you prefer, you can submit claims directly to your insurance the old-fashioned way.
While navigating insurance can feel daunting, our goal is to support you every step of the way. If you have questions about your superbill or reimbursement, don’t hesitate to reach out—we’re here to help!