Shocking facts women need to know about healthcare reimbursement: 5 Critical facts that may transform your health journey

As women, we've been conditioned to trust the traditional medical system without question. What if I told you the way hospitals and healthcare providers get paid might not align with what's best for women’s long-term health?

Understanding the financial incentives behind conventional medical treatment can be eye-opening, and if I’m honest, it is quite shocking but hopefully will empower you to take charge!

The truth is that our healthcare system operates on a model that rewards only managing symptoms of chronic diseases rather than preventing or reversing them. This approach, combined with a significant gender gap in medical research, means women often receive treatments that weren't designed with our unique physiology.

Here are five critical things every woman should know about healthcare reimbursement protocols and why functional medicine might offer an empowering path forward.

1. The System Profits from Keeping You Sick, Not Making You Well

The Reality: Healthcare reimbursement is structured around billing codes for chronic disease management. Hospitals and providers receive higher reimbursements for managing conditions like diabetes, hypertension, and metabolic syndrome with ongoing pharmaceutical interventions rather than addressing root causes. This is how Big Pharma keeps their hold on the system! Providers follow the “standardized protocol” of prescribing medications to get reimbursed. Prescriptions for diet and exercise don’t pad their pockets.

What This Means for You: When you walk into a doctor's office with symptoms of insulin resistance, the profitable approach is to prescribe metformin and schedule regular monitoring visits. The less profitable, but potentially more effective approach would be to spend time addressing your sleep quality, reducing stress levels, balancing nutrient deficiencies, and identifying inflammatory triggers.

The Functional Medicine Difference: Functional medicine practitioners focus on identifying and addressing the underlying causes of your symptoms. While this approach may require more upfront investment in comprehensive testing and lifestyle modifications, it often leads to long lasting health improvements rather than lifelong medication dependence that just keep stacking up as the number of diagnosis expand.

2. Most Medications Weren't Tested on Women—Especially Not Women Like You

The Reality: Until 1993, women of childbearing age were largely excluded from clinical drug trials. Even today, many medications are tested primarily on men, with results generalized for women. This is particularly problematic for medications used in diabetes, weight management, and cardiovascular health.

What This Means for You: The medication your doctor prescribes may have different effects on your body than intended. Women metabolize drugs differently due to hormonal fluctuations, different body composition, and unique liver enzyme activity. Side effects may be more severe, or the medication may be less effective than anticipated. Honestly, who even knows, because they never bothered testing!

The Functional Medicine Difference: Functional medicine considers your unique biochemistry, including fluctuating hormonal patterns, genetic variations, and metabolic differences. In addition, functional medicine considers environmental factors also known as epigenetics and contributing stress levels to determine chronic disease triggers. Instead of a one-size-fits-all pharmaceutical approach, you receive personalized protocols that work with your body's natural processes. What works for one might not help another woman at all!

3. Chronic Disease Management Billing Codes Ignore Common Hormonal Root Causes

The Reality: Insurance reimbursement codes for conditions like "Type 2 Diabetes" or "Obesity" don't account for underlying hormonal imbalances that may be driving these conditions in women. Issues like insulin resistance, thyroid dysfunction, cortisol dysregulation, and estrogen dominance are rarely addressed comprehensively.

What This Means for You: You might spend years managing symptoms with medications while the real culprits, like chronic stress disrupting your cortisol patterns or poor sleep affecting your insulin sensitivity, remain unaddressed. Symptoms will progressively worsen despite following “medical management.”

The Functional Medicine Difference: Comprehensive food or environmental sensitivities, gut microbiome, or hormone testing with clinical assessment may reveal the true drivers of your health struggles. Addressing cortisol dysregulation through stress management techniques, supporting thyroid function with targeted nutrients, and balancing blood sugar through strategic quality nutrition often produces better outcomes than medication alone.

4. The "Standard of Care" May Not Be Standard for Your Biology

The Reality: Medical guidelines are based on population averages, but women's health needs vary significantly based on menstrual cycle phase, shifting life stage of reproductive, perimenopausal, or postmenopausal hormone levels, and individual genetic and epigenetic factors. The reimbursement system rewards following these population-based guidelines rather than individualizing care.

What This Means for You: Your blood sugar targets, blood pressure goals, and treatment protocols are based on what works for the "average" person—not necessarily what's optimal for your unique physiology. For example, premenopausal women may need different diabetes management strategies than postmenopausal women due to estrogen's effects on insulin sensitivity. And those lab ranges that tell you what is “normal” may not indicate what is optimal, but provides an average based on a very unhealthy population in this country.

The Functional Medicine Difference: Personalized medicine considers where you are in your hormonal journey, your genetic predispositions, and your individual response patterns. Treatment plans are tailored to work with your body's current state rather than against it and allow you to determine what makes you feel empowered and what honestly just isn’t working for you!

5. Prevention and Root Cause Medicine Don't Have Profitable Billing Codes

The Reality: Insurance rarely covers comprehensive functional testing, extended consultation time, or preventive interventions like targeted supplementation and nutrition counseling. There's no billing code for "preventing diabetes through lifestyle optimization" or "reversing autoimmune conditions through gut health restoration" but with functional medicine, both are possible and SOOO much more!

What This Means for You: Your conventional doctor may genuinely want to help you prevent disease or address root causes, but the system they work within doesn't financially support this approach. Appointments are rushed, testing is limited to basic panels with suboptimal targets, and treatments focus on symptom suppression rather than healing.

The Functional Medicine Difference: While functional medicine unfortunately require out-of-pocket investments, many women find addressing root causes leads to significant long-term savings. Reversing insulin resistance naturally may eliminate the need for diabetes medications, blood sugar monitoring supplies, and diabetes-related complications. In addition, the sense of empowerment when you gain control over your health!

The Path Forward: Taking Control of Your Health Journey

Understanding these reimbursement realities isn't meant to discourage you from working with conventional healthcare providers when appropriate. Rather, it's about empowering you to make informed decisions about your health journey and consider which approach might feel right for you. Maybe it is a balance of both and not an extreme one way or the other but exploring that there may be an alternative method to consider.

When to consider functional medicine coaching:

·        You've been told your symptoms are "normal" or "just part of aging"

·        You're managing multiple chronic conditions with multiple prescription medications that only control symptoms, not reverse disease

·        Your symptoms persist or even worsen despite following recommended standardized treatment protocols

·        You're interested in disease prevention and optimal longevity, not just disease management

Your Health Is Your Responsibility & Is Within Your Power

The conventional medical system plays an important role in acute care and emergency situations. However, when it comes to chronic disease prevention and reversal, understanding the financial incentives at play may help you make more empowered decisions.

Your health journey is unique, and you deserve an approach that honors your individual biology, addresses root causes, and supports your long-term vitality. Shilling Health & Wellness Coaching offers a client centered functional medicine personalized, root-cause approach—one that is honored to see you as a whole person rather than a collection of billable diagnoses. You are not an average statistic, and your health deserves more than a one-size-fits-all approach designed around reimbursement codes rather than your optimal wellbeing!

Ready to explore a functional medicine approach to your health? Consider scheduling a strategy session with Shilling Health & Wellness Coaching to uncover the root causes of your symptoms and develop a personalized plan for lasting vitality.