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FAQs about Insurance

​​I love accepting insurance! I currently accept PPO plans from Aetna, Unitedhealthcare, Blue Shield of California, and Medicare.  I also accept the Hill Physicians HMO. It's essential to me to increase the amount of people I can help by taking insurance. That being said, it is the client's responsibility to know and verify their insurance benefits before a nutrition counseling session.  It is strongly recommended that you call your insurance company 48 hours before your session to confirm coverage. 

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*Please note that I am considered out-of-network with PPO plans from Anthem Blue Cross and Cigna. I am happy to generate a Superbill for members to submit for out-of-network benefit reimbursement. 

 

Here is a list of questions to ask:

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  1. Do I have coverage for nutrition counseling?

  2. Do I need a referral to see a Registered Dietitian?

  3. Are my diagnoses covered on my particular plan?

  4. How many visits per calendar year do I receive?

  5. Do I have a cost-share for these services?

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

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And here is even more information about why these questions matter, so you have the context to ask your insurance company further questions if you are confused.

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

  • A: You will likely need to provide the CPT/procedure code for my services, and a diagnosis code from your doctor. If the insurance company asks for a CPT code (or procedure code) please provide them with the following codes 97802 and 97803. These are the most common procedure codes covered by insurance companies. 

  • Q: Will my diagnosis be covered?

  • A: 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 your BMI is above 25 or if you have pre-diabetes, diabetes, hypertension, or high cholesterol you may want to see what your coverage is for these diagnoses as well. Email me with questions about this! 

    • I always code your visit 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. 

  • Q: How many visits do I have per calendar year?

  • A: Your insurance 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.

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

  • A: 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. 

  • In the event, you have a  cost-share I will initially bill your insurance company directly.  Once I receive the EOB describing your responsibility as the patient, I will bill the credit card on file for the amount noted under ‘patient responsibility. For most insurance companies dietitians are considered a specialist. I will 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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