Functional Neurology (FN) is a specialized, non-invasive approach focused on addressing neurological issues by optimizing the function of the nervous system. This discipline uses targeted stimulation to encourage neuroplasticity, the brain’s ability to reorganize itself and form new neural connections. Whether treatment is covered by insurance is highly variable and complex, depending heavily on the specific insurance plan, the state where care is received, and the professional license of the provider. Understanding these nuances is necessary for anyone seeking care from a functional neurologist.
Understanding the Nature of Functional Neurology
Functional Neurology examines the dynamic interactions between the brain, spinal cord, and peripheral nerves to identify subtle dysfunctions not apparent on standard tests. The approach emphasizes non-drug, non-surgical treatments aimed at stimulating underperforming neural pathways. Treatment plans are highly individualized, leveraging neuroplasticity to encourage functional recovery.
FN practitioners utilize specialized, targeted rehabilitation exercises. These therapies often include specific eye movement drills, balance and coordination training, and various forms of sensory stimulation. Because these methods fall outside the established protocols of traditional medicine, insurance companies often find them difficult to categorize and review.
Insurance Categorization and Coverage Status
Coverage for Functional Neurology is inconsistent because many insurers struggle to classify the specialized treatments. Many private insurance companies and government programs like Medicare and Medicaid frequently classify specialized FN treatments as “investigational,” “experimental,” or “alternative medicine.” This categorization often leads to outright denial of claims for the functional neurological care itself.
Denial is often based on the lack of large-scale, randomized controlled trials that meet the payer’s criteria for medical necessity. Coverage is usually provided only when the FN practitioner performs procedures that align with standard, recognized medical or chiropractic services. For example, a chiropractic adjustment or physical therapy performed during an FN session may be covered, but specialized visual or vestibular rehabilitation drills are not. Patients may receive partial reimbursement for a visit, but the core functional neurological component remains an out-of-pocket expense.
Billing Codes and Provider Licensing Requirements
Insurance coverage hinges on the CPT (Current Procedural Terminology) codes used to describe the procedure and the ICD-10 (International Classification of Diseases, 10th Revision) codes used to justify the diagnosis. While conditions treated by FN, such as Functional Neurological Disorder (FND), have recognized ICD-10 codes, procedural codes often create a technical barrier to reimbursement. Many specific FN therapies lack dedicated CPT codes, forcing practitioners to use general or “unlisted procedure” codes, which payers frequently reject.
The provider’s professional license further complicates coverage determination. The majority of Functional Neurologists are Doctors of Chiropractic (DC) who have completed extensive post-graduate training, often certified by the American Chiropractic Neurology Board (ACNB). A DC’s scope of practice is subject to different insurance rules than that of a Medical Doctor (MD) or Doctor of Osteopathy (DO) who may also practice FN. This difference means a service performed by a DC may be denied as a “non-covered provider service,” even if the identical procedure performed by an MD would be reimbursed.
Patient Strategies for Verifying Coverage and Managing Costs
Patients should proactively contact their insurance carrier to verify benefits before beginning treatment, using the specific CPT codes provided by the neurologist’s office. Ask the insurer if the provider is in-network and if the intended procedural codes are covered for the diagnosis. Getting verification or pre-authorization in writing can help avoid unexpected costs.
Thorough documentation is important, especially when navigating the appeals process for denied claims. If the treatment is deemed medically necessary by a referring physician, this documentation can challenge an initial denial. Since many FN clinics operate on a cash-based model due to unreliable reimbursement, patients should inquire about payment plans or negotiated cash rates. Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) can often be used to pay for qualified medical expenses, effectively using pre-tax dollars to cover out-of-pocket costs.