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Hello everyone,

I was asked to write this week’s newsletter, as the front office has faced numerous challenges in navigating lab testing orders, whether they can be done by your medical doctor and if insurance will cover them.

A common question we hear from people interested in becoming a patient is: “I just had a bunch of tests done by my doctor, can I use these results?” OR “Can’t I just order them through my doctor?”

I will explain why we recommend ordering our comprehensive standard panel vs. relying on conventional labs.

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Conventional “Routine” Labs

Conventional doctors order “routine labs” to diagnose disease and prescribe medication. They are looking at “normal ranges” to monitor when your numbers start going into a disease state, then they can prescribe medication (or other medical procedures) to attempt to get these levels back to “normal”.

The most common tests that patients bring in from their doctor are: a Comprehensive Metabolic Panel (CMP), Complete Blood Count with Differential (CBC with Diff), and occasionally a Lipid Panel (Cholesterol).

Let me break it down for you:

Comprehensive Metabolic Panel (CMP) – Checks Fasting Glucose, electrolyte balance (Sodium, Potassium, Chloride), and assesses the function of the liver and kidneys.

Complete Blood Count with Differential (CBC with Diff) – Counts the cells in your blood to detect infections, anemia, and diagnose blood disorders.

Lipid Panel – Measures the levels of different types of fat in your blood. Medical doctors use this to check the need for Cholesterol meds.

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What Conventional Labs Are Missing

First, let’s go over what is missing from these tests. While the panels above seem to cover a lot, you may be shocked when you realize what they are missing.

Keep in mind that we are looking at these tests differently, in that we are looking at FUNCTION and not to diagnose DISEASE. We use functional lab ranges to assess optimal health and detect imbalances, instead of conventional lab ranges that make your results seem “normal” while you still have symptoms and are not feeling your best.

For example, Fasting Glucose shows what your glucose level is on the day you got your blood drawn, but without HbA1c, Fasting Insulin, and HOMA-IR score, there is no way to determine what your long-term blood sugar balance looks like or if you have insulin resistance, which is associated with heart disease, cancer, Alzheimer’s, diabetes, arthritis, hormonal issues, and more. We also consider the Triglyceride/HDL ratio from the lipid panel.

There are no inflammatory markers such as CRP, Ferritin, Fibrinogen Activity, or Homocysteine.

It doesn’t assess important vitamin needs, such as B vitamins that prevent heart disease or Vitamin D.

The panels above don’t assess thyroid function. While some doctors may run TSH, TSH is actually a brain hormone that signals the thyroid to manage thyroid hormone balance. That is why we check not only TSH, but the thyroid hormones such as Total and Free T3 and T4. We also check Thyroid Antibodies at least once for every patient, which shows an autoimmune pattern affecting the thyroid (think: Hashimoto’s) that affects 12% of the population, mainly women.

There is no iron panel, which can indicate too much iron or too little iron. The biggest mistake we see is ordering a CBC with Differential and thinking this assesses iron. It does not! It assesses anemia, which is not the same thing as iron deficiency. You can have anemia while also having high iron. Our iron panel also includes Ferritin, which shows iron storage and is a dual marker for inflammation.

And finally, the panels that conventional doctors order NEVER include IgG food sensitivities to common foods such as wheat, gluten, dairy, and eggs. In fact, whenever a patient asks their doctor to order them, and we provide the codes to order them, they ALWAYS order the IgE tests (which show allergies to foods instead of sensitivities).

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Does Insurance Cover Functional Lab Testing?

Now that you understand why we can’t rely on conventional lab testing to do our nutritional assessment, here’s why it’s not economical or effective to rely on your insurance to cover our comprehensive lab panel.

Most insurance companies do not consider preventive or functional labs “medically necessary”. If you call your insurance company and ask an agent if lab tests are covered by your plan, most will say “yes, as long as it’s medically necessary”.

What does that mean? The definition from healthcare.gov states: “Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms that meet accepted standards of medicine”. Basically, insurance only covers lab testing if you already have a diagnosis or your doctor is looking to diagnose you with a condition.

Since we don’t diagnose conditions, we only provide preventive screening codes that most insurance companies will not cover.

Much like your car insurance doesn’t cover general maintenance of your car, your health insurance doesn’t cover preventive health.

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The Challenges of Having Your Medical Doctor Order Functional Labs

In theory, yes, your medical doctor could order the tests in our panel and provide diagnostic codes that your insurance will cover. Here are the issues that we have seen with going that route:

1. Many doctors are hesitant to order all tests included in our panel due to insurance restrictions and diagnostic limitations.

2. When they don’t order all the tests, patients must go back to the lab and get their blood drawn a second time to get what’s missing.

3. The turnaround time to get results in patients’ hands is up to 2 weeks! This stalls your treatment plan.

4. In the past, we have tried ordering directly through the laboratory so they could bill the patient’s insurance and that patient ended up with a $2,000 bill! Their insurance was billed at retail prices and denied the claim.

We understand that with rising insurance premiums, it makes sense to want to use your insurance for expenses like lab testing. However, the reality is that health insurance is not designed to cover tests when viewed through a functional health perspective.

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Advantages of Ordering Our Comprehensive Panel Directly Through Our Office

Now, here are the benefits of ordering our panel through our office:

1. We get wholesale pricing through our lab co-op. The same labs that cost $2,000 retail, cost just $400 through our co-op. Individual tests are fairly cheap. For example, our CMP panel is only $20!

2. We receive the results directly from our lab portal as soon as 2 business days!

3. We can provide an itemized receipt (excludes Medicaid/Medicare) that you can submit to your insurance for possible reimbursement. This way, the worst-case scenario is they deny the claim but won’t be sending you that $2,000 bill.

4. The best part? You’ll gain a wealth of insights into how your body is functioning, plus access to a practitioner who can interpret the results and create a personalized plan to boost your energy, improve digestion, reduce chronic pain and inflammation, and enhance your overall wellness!

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I know this was a lengthy email, but I hope it has helped clarify the difference between medical and functional lab testing. The more you understand, the better equipped you’ll be to make informed decisions about your health. If you have any questions, feel free to call the front office, and I’d be happy to guide you through the process.

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To your radiant good health!

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Sincerely yours,

Jennifer Bunting

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