Please note it is the patient’s responsibility to call their insurance company to confirm coverage PRIOR to their visit. We don’t want our patients to have any surprise bills.
Do I have nutrition counseling coverage on my insurance plan?
- If the insurance company asks for a CPT code please provide them with the following codes 97802, 97803 and 97804. 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. We also can 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 your BMI (body mass index) technically falls under the categories of overweight or obese, or you have pre-diabetes, diabetes, hypertension, or high cholesterol you may want to see what your coverage is for these diagnoses as well.
- We 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 your BMI does not fall in the overweight category or you don't have cardiovascular risk factors) your insurance may impose a cost-share for your visit either in the form of a deductible, co-pay or co-insurance.
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 varies from 0 to unlimited, depending on medical need.
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.
- We will 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 is 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 (explanation of benefits) describing your responsibility as the patient, we will bill the credit card on file 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, if we 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 for the co-pay amount.
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?
If you have any questions after verifying your benefits we are happy to help. Please email firstname.lastname@example.org. We will typically return your message within 48 business hours.