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Using Insurance Coverage

  • It is often not common knowledge that most of the major insurance companies provide coverage for visits with a dietitian, but they do! Some plans even cover unlimited visits in a year!

  • Currently I am in-network with Aetna, United Healthcare, MedCost and Blue Cross and Blue Shield. This means I can currently bill these providers for nutrition counseling services if they are covered under your plan. I am out-of network for all other insurance providers which means I cannot bill insurance directly, but I can provide you with a Superbill that you can submit for reimbursement if you have out-of-network benefits.

  • If you are out-of-network payment for services is due at time of service.

  • It is vital that YOU call your insurance provider and verify the benefits you have for nutrition counseling for your specific plan.

  • Start by calling the 800 number on the back of your insurance card and ask to speak with a representative. Then use the script below to guide the questions you ask your representative. Again, this works best is YOU call prior to your first appointment.

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Please note it is the client’s responsibility to call their insurance company PRIOR to your visit to confirm coverage. This helps avoid any surprise payments.

What to say to your insurance representative:

*Note: Make sure to record the representative’s name and reference # when checking your benefits. This information will be necessary if you ever need to dispute a rejected claim.

  • Do I have nutritional counseling coverage on my insurance plan?

    • If the insurance company asks for a CPT code please provide them with the following codes 97802 & 97803. If they say you do not have coverage using those codes NEXT ask them to check your coverage for the following CPT codes: 99401, 99402, 99403 and 99404. It may also be possible to bill for S9470 if it is covered on your policy. 

 

  • Will my diagnosis be covered?

    • If the representative asks for a diagnosis code (aka ICD 10 code) – please tell them the visit is coded the ICD 10 code: Z71.3

    • If they don’t accept Z71.3 then provide them with Z72.4 and see if they will cover that diagnosis instead on your plan. 

    • If you are overweight, obese, have pre-diabetes, diabetes, hypertension, or high cholesterol you may want to see what your coverage is for these diagnoses as well.

 

  • Your visit is always coded using preventative coding (if applicable) to maximize the number of visits you receive from your insurance carrier. However, if you ONLY have a medical diagnosis (for example: IBS, and you are not overweight or have CVD risk factors) your insurance may impose a cost-share for your visit either in the form of a deductible, co-pay or co-insurance. 

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  • How many visits do I have per calendar year?

    • Your carrier will let you know how many visits they are willing to cover. Depending on the carrier the number of visits vary from 0 to unlimited depending on medical need.

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  • Do I have a cost-share for my nutrition visit?

    • A cost-share is the amount you will need to pay as required by your particular insurance plan towards your services. A cost-share can be in the form of a deductible, co-pay or co-insurance. 

    • Sessions are always bill under your insurance policy’s plan under your preventative benefits if your plan allows. With that being said, if you have preventative benefits there if often NO cost share for you associated with the visit. Once again, this is something YOU do want to ask prior to your visit. 

    • In the event you have a  cost-share we will initially bill your insurance company directly.  Once we receive the EOB describing your responsibility as the patient, the credit card on file will be billed for the amount noted under ‘patient responsibility.

    • For most insurance companies dietitians are considered a specialist. Therefore, your specialist co-pay is applicable and is payable at the time of service. This information is often apparent on the front of your actual insurance card. However, often because I bill your insurance with preventative counseling the co-pay is often not applicable.

    • We generally wait for the claim to be processed to determine whether or not you have a co-pay and then charge the credit card you have on file with us the co-pay amount. 

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  • Summary of questions to ask to verify your nutrition benefits

    • Do I have coverage for nutrition counseling?

    • Do I need a referral to see a Registered Dietitian?

    • Are my diagnoses covered on my particular plan?

    • How many visits per calendar year do I receive?

    • Do I have a cost-share for these services?

    • Is there an associated cost for me if I choose to have the appointment as a telehealth visit versus in person visit?

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