Aetna generally does not cover functional medicine as a whole, considering many of its methods experimental or investigational. Some elements like lab tests or nutritional counseling may be reimbursed if they meet medical necessity criteria within a member’s specific plan.
You can refer to Aetna’s official policy on diagnostic testing, integrative medicine, or consult your plan documentation directly for clarity.
If you’re an Aetna customer wondering whether your plan covers functional medicine, here’s how you can find out (reference):
- Review Your Policy: Start by thoroughly reading your Aetna insurance policy. Look for terms like “preventive services,” “nutritional counseling,” or specific diagnostic and treatment codes related to functional medicine.
- Contact Aetna Member Services: Call the number on your insurance card and ask directly about coverage for specific functional medicine services, such as lab tests or consultations. Be ready to provide detailed information about the services you’re seeking.
- Request Pre-Approval: For certain services, you may need to request prior authorization to confirm coverage.
- Check for Reimbursement: Even if functional medicine services are not covered upfront, some plans might reimburse you partially for out-of-pocket expenses. Functional medicine providers often provide detailed receipts with appropriate codes, which you can submit to Aetna for potential reimbursement.
- Understand Coverage Limits: Functional medicine is often excluded or considered experimental in insurance plans. If covered, the scope of coverage may be limited to specific medically necessary services that align with conventional care.
By following these steps, you can confirm whether your Aetna plan provides any functional medicine benefits and what your financial responsibility might be.
