Plan on using insurance for sessions?

Before your first session:​

Please note: it is your responsibility to call your insurance company prior to your first visit to confirm insurance benefits as your coverage could have limitations or specific qualifications for nutrition care.

If our services are considered out-of-network, we can provide a monthly superbill that you can submit to your insurance company. When submitting a superbill, there is no guarantee that your insurance will cover the visits. You would still need to be responsible for your visits whether or not they end up being covered. Please see below for the questions to ask your insurance representative before making an appointment, as you will be responsible for any fees not covered by insurance.

Ask your insurance company and document the following:

1. Is preventative nutrition counseling or medical nutrition therapy covered?

If yes, please ask them if the following CPT codes are covered: 97802, 97803, 99401, 99402, 99403, 99404, and S9470.

2. Will the following diagnostic code will be covered?

Ask the representative if the following diagnostic code, also known as an ICD 10 code is covered: Z71.3. We always try to use this code for nutrition counseling to maximize the number of visits you receive from your insurance carrier.

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

2. Is a referral needed? If so, is a specific diagnosis needed on my PCP referral?

If a referral is needed, be sure to ask your insurance company if there are specific diagnoses (overweight, obesity, diabetes, high blood pressure, etc) that are required in order to have coverage for sessions. You can request a referral from your doctor and have it faxed to us. We must have the referral PRIOR to your first appointment if it is required for insurance coverage.

3. Are telehealth visits covered?

Many plans have extended coverage to include Telehealth, specifically for preventative health services. Please check with your representative.

4. How many visits do I have covered per calendar year? Are there a maximum number of visits allowed?

Your carrier will let you know how many visits or units they are willing to cover. Depending on the carrier, the number of visits varies from 0 to unlimited depending on medical needs and diagnoses. 

5. Do I have a deductible?

Often, preventative services do not require you to meet your deductible for coverage of sessions. However, your policy may state a deductible has to be met before the insurance company will pay if there is a cost share. If you haven't met that deductible, you may have to pay out-of-pocket until you meet your deductible. We will provide you with the appropriate documentation to submit to your insurance company to show receipt of the services. This will allow you to “pay down” your deductible if there is a cost share. Once your deductible has been met, we can then directly bill your insurance company if nutrition services are covered.

 6. Is there a cost share for my nutrition visit?

A cost-share is the amount your insurance plan requires that you pay for services. This can be in the form of a deductible, co-pay, or co-insurance. 

If you have preventive benefits, there is often no cost share associated with the visit, however, this is something you do want confirm with your representative before your visit. If not, a specialist co-pay may be applicable. This cost is often listed on your insurance card. However, because we typically 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 you have a co-pay, and then charge the credit card on file with us the co-pay amount. Any payments that are rejected or insufficiently funded will be the client's responsibility to cover within 30 days of receiving written notice. We also accept HSA/FSA and credit/debit cards as acceptable forms of payment.

7. Ask for the reference code for your conversation with the representative you speak with.

This is helpful, especially in the event that coverage is denied. We will do our best to optimize your coverage.