If you are considering becoming a patient at JustBeWell, one of the first things you will notice is that we do not accept insurance.

Before I explain why, I want to show you a number.

What American Families Are Already Spending

The 2025 average employer-sponsored family health insurance premium is $26,993 per year. The employee directly contributes about $6,850 of that. The employer pays the remaining $20,143 — which sounds like a benefit until you realize that economists broadly agree this contribution is part of your total compensation, money that might otherwise appear in your paycheck.

On top of the premium, a claims-based analysis found that a family of four with employer coverage incurs about $3,564 per year in actual out-of-pocket costs — deductibles, copays, and coinsurance on the care they actually use.

Add those together and the total economic cost of healthcare for a typical insured family of four is approximately $30,557 per year.

Now consider how often that family actually sits face to face with a physician.

CDC data on office visit rates suggests that a family with two adults under 45 and two children experiences roughly 6.8 physician office visits per year — essentially seven visits for the whole family. Children average about 1.53 visits annually. Adults aged 18 to 44 average about 1.88.

That works out to approximately $4,500 in total healthcare spending for every physician office visit the family experiences.

From the family's own visible household budget — just the employee premium contribution plus out-of-pocket costs, not the employer's share — the number is about $10,400 per year, or roughly $1,500 of direct family spending per physician visit.

To be clear about what these numbers mean: insurance is also purchasing hospitalization coverage, prescription benefits, surgery, emergency care, imaging, and catastrophic risk protection. A physician office visit is not literally costing $4,500. These figures reflect the full cost of the coverage arrangement, not the cost of any single service.

But here is what I think is worth sitting with.

A typical insured American family now has more than $30,000 a year flowing into its healthcare coverage and out-of-pocket spending. In return, every member of that family may see a physician — briefly, under time pressure, organized around a billing code — about seven times during the entire year.

I am not arguing that insurance is bad. People need catastrophic coverage. I am asking whether this arrangement, as currently structured, is actually delivering what most patients with complex chronic illness need.

Because for those patients, I do not think it is.

Insurance Is a Measurement System, Not Just a Payment System

Albert Einstein is often credited with observing that not everything that counts can be counted, and not everything that can be counted counts.

The attribution is disputed among scholars, but the idea is precise — and it applies directly to medical insurance.

Insurance is not simply a method of payment. It is also a system for defining what care is being provided, why it is being provided, and under what circumstances that care qualifies for reimbursement. Once care is submitted to an insurance company — even if the patient is the one physically submitting the claim — we have entered that system.

And much of the medicine practiced at JustBeWell does not fit comfortably inside it.

To understand why, it helps to understand how medical insurance actually works.

A medical claim connects a diagnosis with a service. Diagnoses are represented with ICD-10 codes and physician services with CPT or HCPCS codes — a standardized structure that allows insurers to process claims across millions of patients. Medicare states that covered services must generally be "reasonable and necessary" for the diagnosis or treatment of illness or injury. Private insurers use similar language. The American Medical Association's definition of medical necessity includes whether care is consistent with generally accepted standards of medical practice and clinically appropriate in type, frequency, extent, site, and duration.

None of this makes insurance bad. It is simply how a large reimbursement system has to function. An insurer cannot individually read the biological story of every patient. It needs standardized answers to standardized questions: What diagnosis does this patient have? What service was performed? Was that service reasonable and necessary for that diagnosis?

The difficulty is that this structure can be a poor fit for the way we think about complex chronic illness.

The Diagnosis Is Only Part of the Story

In functional medicine, we make an important distinction.

A diagnosis tells us how you are similar to other people who share that diagnosis. Functional medicine also asks what makes your particular case different.

If you have rheumatoid arthritis, psoriasis, diabetes, migraine, or inflammatory bowel disease, the diagnosis is enormously valuable. It connects us with everything medicine has learned from thousands of other people with the same condition.

But it does not necessarily tell us why you developed the illness, why it developed when it did, or which factors are continuing to influence its expression.

That difference becomes particularly important when we start deciding what to treat.

Suppose you come to us with inflammatory arthritis.

In a conventional, diagnosis-based model, the treatment naturally focuses on the arthritis. There are established medications and treatment pathways for inflammatory arthritis, and many of them are extremely important. We may use those treatments. We may also want a rheumatologist involved.

But the investigation may take us somewhere else as well.

We may find substantial gastrointestinal dysfunction. We may become concerned about intestinal barrier integrity, altered microbial ecology, an ongoing antigenic stimulus, metabolic inflammation, sleep disruption, or nutritional inadequacy.

Now suppose we decide part of the strategy for your arthritis should involve addressing your gastrointestinal system.

From a functional medicine perspective, that makes good biological sense. The gastrointestinal tract is one of the major interfaces between the outside world and the immune system. Gut microbes and their metabolites interact extensively with immune regulation, and there is substantial scientific literature examining the relationships among the microbiome, intestinal immunity, and systemic inflammatory disease.

But now try to put that reasoning on an insurance claim.

The claim asks, in essence: what service was provided and what diagnosis justifies it?

If the diagnosis is inflammatory arthritis and the intervention is directed primarily at gastrointestinal physiology, the relationship may not fit an insurer's covered indication or medical necessity policy. It may be viewed as outside an established treatment pathway for that diagnosis.

That does not mean the insurer is behaving irrationally. It is simply asking whether a particular service is a covered and medically necessary treatment for a particular condition.

The problem is that functional medicine is often asking a different question entirely.

Biology Does Not Follow Billing Categories

This is really the heart of the issue.

The body does not know that gastroenterology and rheumatology are different departments.

The immune system communicates with the gut. The gut communicates with the brain. Metabolism influences immune behavior. Sleep alters endocrine, neurological, metabolic, and inflammatory physiology. Adipose tissue produces signaling molecules. Skeletal muscle communicates metabolically with the rest of the body. Psychological stress can alter autonomic and endocrine signaling, which can in turn influence immune and metabolic function.

As W. Edwards Deming observed: "A system must be managed. It will not manage itself."

He was describing organizations. But the principle maps directly onto human physiology. The body is a system. Its components do not operate independently, and understanding why one part is failing often requires examining the parts it is communicating with.

Modern systems biology increasingly describes disease in terms of interconnected networks rather than isolated organs. Barabási, Gulbahce, and Loscalzo described this network approach to human disease in Nature Reviews Genetics, emphasizing that disease phenotypes arise within interconnected molecular and biological networks.¹

Functional medicine tries to bring that same systems perspective into clinical care.

Insurance, by necessity, has to translate what we do back into standardized categories.

Those two ways of organizing information are not always compatible.

This Does Not Mean We Ignore the Standard of Care

Choosing not to participate in insurance does not mean that we believe established medical standards are irrelevant. Quite the opposite.

If you have rheumatoid arthritis, we want to know what evidence-based rheumatology has learned about rheumatoid arthritis. If you have coronary artery disease, we want the benefit of modern cardiology. If you have cancer, we want appropriate oncology involved. If you have an infection requiring antibiotics, we are going to use antibiotics.

Functional medicine should add to good medicine, not replace it.

But the standard disease-specific treatment may not be the end of the investigation.

We may also ask why this disease developed in this person and what is influencing the biological terrain in which it is occurring. That may lead us to interventions that do not have an obvious one-to-one relationship with the diagnostic code on an insurance claim.

We might work on sleep in a patient with insulin resistance. We might address metabolic dysfunction in someone with inflammatory disease. We might investigate gastrointestinal physiology in someone with autoimmunity. We might spend considerable time evaluating environmental exposure in someone with neurological or immune symptoms.

These are not necessarily substitutes for conventional treatment. They are often another layer of treatment.

That distinction can be difficult to represent in a reimbursement system designed around diagnosis-linked medical necessity.

Why Not Just Give You a Superbill?

Some cash-based practices do exactly that. The patient pays for the visit, receives a superbill containing diagnostic and procedure codes, and submits it to the insurer for possible out-of-network reimbursement.

We have made a deliberate decision not to do that.

The reason is that once we create an insurance claim, regardless of who submits it, we are participating in the claims process. The claim still needs diagnosis codes. It still needs procedure codes. The insurer can still determine whether the service was covered, whether it was medically necessary, whether the diagnosis supports the service, and whether the documentation justifies reimbursement.

At that point we are once again being asked to translate the work we did together into the language of an insurance reimbursement system.

We do not want to practice two different versions of medicine: the medicine we believe the patient needs, followed by a second version constructed to fit a claim.

So we keep the boundary clean.

You pay us for the professional work we do together. We do not represent that work to your insurer for reimbursement, either directly or indirectly.

This Gives Us an Important Kind of Freedom

The greatest advantage is not administrative. It is clinical.

It means the first question does not have to be: Will insurance cover this?

Instead, we can ask: Does this make sense for this patient?

Those are sometimes very different questions.

It allows us to spend more time on the history when the history is where the answer may be hiding. It allows us to explore relationships among systems rather than being limited to the organ associated with the diagnosis. It allows us to decide that the most important intervention right now might be food, sleep, movement, metabolic health, the gastrointestinal system, nervous system regulation, an environmental exposure — or something else entirely.

It also allows us to decide not to do something.

More functional medicine testing is not always better. More supplements are not necessarily better.

Sometimes the right decision is that a test is unlikely to change what we do. Sometimes the best treatment is remarkably simple.

Voltaire put it plainly: "The art of medicine consists of amusing the patient while nature cures the disease." He was being satirical — but embedded in the satire is a real warning. Doing more is not always doing better.

Freedom from insurance should not mean freedom from rigor.

It should mean freedom to apply rigor to the actual patient, rather than to the requirements of a reimbursement system.

There Is a Cost to This Choice

We do not pretend otherwise.

When insurance does not reimburse for our care, you are paying for that care yourself. For some patients, that is a significant limitation, and we understand that.

Insurance is enormously valuable. We want insurance coverage for hospitalization, surgery, emergency care, advanced imaging, specialty procedures, expensive medications, and cancer treatment — all of the things modern healthcare can provide.

Our position is not that insurance is unnecessary.

Our position is much narrower:

We do not think insurance is the right mechanism for paying for the kind of exploratory, individualized, systems-based chronic disease work we do in this clinic.

Those are different statements.

Is This Just an Excuse to Practice Outside the Evidence?

It should not be.

In fact, the opposite standard should apply.

If we have chosen the freedom to think more broadly, then we carry a greater responsibility to explain why we are doing what we are doing. Does the proposed mechanism make biological sense? Is there evidence supporting it? How strong is that evidence? Are we dealing with an established intervention, an emerging idea, or a hypothesis? What are the risks? How will we know whether it is working?

Functional medicine itself is still developing an evidence base as an integrated model of care. A Cleveland Clinic observational study involving more than 7,000 eligible patients found greater improvement in patient-reported physical health at six months among propensity-matched patients receiving functional medicine care compared with conventional family health center care. The authors appropriately emphasized that the results were observational and hypothesis-generating rather than proof of causation.²

That is how the field should develop.

Test the ideas. Keep what works. Modify what is incomplete. Abandon what does not hold up.

As the statistician George Box observed: "All models are wrong, but some are useful." Functional medicine is a model — not a finished science — and it should be held to the same discipline of testing and revision that any useful model requires.

What You Are Actually Paying For

Ultimately, you are not paying us to generate a billing code.

You are paying for our time, our clinical judgment, our ability to organize a complicated history, our interpretation of the available evidence, and our attempt to understand how the different pieces of your physiology fit together.

Sometimes that will lead us directly back to conventional medical treatment.

Sometimes it will lead us into nutrition, exercise, sleep, gastrointestinal physiology, metabolic health, immune regulation, environmental medicine, or nervous system regulation — areas that may seem far removed from the diagnosis written at the top of your chart.

That is intentional.

Your diagnosis tells us something enormously important about you.

It tells us how you resemble other people with the same disease.

But you are not simply an insurance diagnosis.

You are one particular human being who arrived at this point through a particular combination of genetics, experiences, exposures, physiology, choices, strengths, and vulnerabilities.

Maya Angelou wrote: "You are the sum total of everything you've ever seen, heard, eaten, smelled, been told, forgot — it's all there." She was describing personhood, not physiology. But the principle is the same. Your illness did not arrive from nowhere, and the path toward health is not a generic one.

Functional medicine is our attempt to understand that larger story.

And our decision not to participate in insurance is ultimately about preserving the freedom to follow that story wherever the biology leads.

If you are skeptical about that, good.

You should understand why we have made this choice before deciding whether this kind of care is right for you.



-Dr. Sult

References

1. Barabási AL, Gulbahce N, Loscalzo J. Network medicine: a network-based approach to human disease. Nature Reviews Genetics. 2011;12(1):56-68. doi:10.1038/nrg2918.

2. Beidelschies M, Alejandro-Rodriguez M, Ji X, Lapin B, Hanaway P, Rothberg MB. Association of the Functional Medicine model of care with patient-reported health-related quality of life outcomes. JAMA Network Open. 2019;2(10):e1914017. doi:10.1001/jamanetworkopen.2019.14017.

3. Centers for Medicare & Medicaid Services. Medicare Coverage Determination Process. Medicare coverage generally requires items and services to be reasonable and necessary for diagnosis or treatment. Accessed August 2026.

4. Centers for Medicare & Medicaid Services. Medicare Billing: CMS-1500 & 837P. CMS Medicare Learning Network. Professional claims require standardized reporting including ICD-10 diagnosis codes and CPT or HCPCS service codes. Accessed August 2026.

5. American Medical Association. Definitions of Screening and Medical Necessity, Policy H-320.953. AMA PolicyFinder. Medical necessity includes care that is clinically appropriate and consistent with generally accepted standards of medical practice. Reaffirmed 2023.

6. Centers for Medicare & Medicaid Services. Evaluation & Management Services. Medicare Learning Network. Documentation must support the CPT, HCPCS, and ICD-10-CM codes reported on claims, with medical necessity serving as a principal criterion for payment. Accessed August 2026.

7. KFF Health Benefits Survey 2024. Employer Health Benefits: 2024 Summary of Findings. kff.org. Accessed August 2026.

8. Health Care Cost Institute. 2022 Employer-Sponsored Health Insurance Report. healthcostinstitute.org. Accessed August 2026.

9. Centers for Disease Control and Prevention. National Ambulatory Medical Care Survey: 2019 National Summary Tables. cdc.gov/nchs. Accessed August 2026.