Will Insurance Cover My Visit?
Due to the many types of insurance plans and policies, the provider can’t know your specific policy or plan requirements. Patients are responsible for knowing and understanding all applicable insurance policies. To obtain accurate billing information, we require a copy of your insurance card and identification card prior to your appointment. Note that we cannot file or accept the assignment of your insurance unless you provide proof of all insurance information. Failure to provide sufficient insurance information 48 hours prior to your appointment time will result in you being charged the self-pay rate.
PLEASE NOTE: we do not verify benefits on behalf of our patients. Use the helpful information below or call the number on the back of your insurance card for plan details and coverage for nutritional counseling.
Some Anthem HMO plans require an insurance referral or preauthorization to see a specialist (these are most often the Anthem Pathway X Guided Access plans). Please check the front of your card for a PCP’s name and phone number. Often, the back of your card has the wording: “referral required to see specialist”. This can be confusing, as it is not a normal referral that they need. Your current primary care physician (PCP) linked to your account needs to contact your insurance provider to initiate a referral. Once this process is complete, a prior authorization or UM# will be created. We cannot submit your claim to insurance until we have this number. If your current PCP is not the one listed on the front of your card, please call the number on the back of your card to link your current PCP to your account.
Please note that we now require referrals from a physician (not physician’s assistant or nurse practitioner ) for all Aetna patients. This is true even if your personal plan does not require referrals. This is part of our provider contract with Aetna in conjunction with their policy on Nutritional Counseling. Click here to read Policy 0049. Please call your primary care physician (or specialist) and have them fax a referral for nutritional counseling to: 833-875-6792 .
Every plan is different, however a lot of the Cigna plans have maximum of 3 visits for nutritional counseling/medical nutriton therapy (CPT 97802/97803) per calendar year. However, some plans often have unlimited visits for preventative medicine counseling (CPT codes 99402,99403,99404); however the sessions using preventative medicine counseling need to be in person.
Please note: Currently, we are NOT part of the HMO Connect plan. If you have this type of Cigna plan we are considered out of network. Please check before your appointment if you have out of network benefits.
Please keep in mind that Medicare will only cover nutrition counseling with a diagnosis of diabetes or renal disease; we need a referral on file in order submit a claim to Medicare. Other conditions will NOT be covered if Medicare is your only carrier. THIS INCLUDES MEDICARE ADVANTAGE PLANS. IF YOU HAVE A MEDICARE ADVANTAGE PLAN AND DO NOT HAVE THE CONDITIONS MENTIONED ABOVE, YOU WILL NEED TO BE A SELF-PAY PATIENT.
Don’t See Your Provider?
If you don’t see your provider listed, then we are considered OUT OF NETWORK with any other provider. If you would like to use an out of network insurance provider, you would pay our self-pay rates at the time of service and we can provide a Superbill that you can submit to your provider for reimbursement. Just let us know!
Our self-pay rates are $155 for the Initial Consulatation and $85 for follow ups.
Frequently Asked Questions for Insurance Company
What if the insurance company asks for a CPT code?
What if I need continuous glucose monitoring?
We are now offering continous glucose monitoring at our office locations. Please verify with your insurance provider if the CPT code 95249 is a covered service.
Will my diagnosis be covered?
If the representative asks for a diagnosis code – please tell them the visit is coded the ICD 10 code: Z71.3 for medical nutrition therapy/ nutritional counseling. We always try to code your visit using preventative coding to maximize the number of visits you receive from your insurance carrier. Aetna also typcially has obesity prevention coverage on most plans.
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 needs. In our experience, Cigna usually covers 3 visits per calendar year.
Are telethealth visits covered?
We have started to see some plans drop their telehealth coverage. Please check with your provider.
What if I have met my deductible?
In the event that you have a deductible AND you have an out of network carrier, we will not be able to initially bill your insurance company directly. Therefore, payment of $155.00 is due at the initial visit and $85.00 is due at each follow-up visit.
We will provide you will the appropriate documentation to submit to your insurance company to show receipt of the services. This will allow you to “pay down” your deductible. Once your deductible has been met and you have nutrition services on your policy, I can then directly bill your insurance company.
Do I have a co-pay for nutritional counseling?
For most insurance companies we are considered specialists. Therefore, your specialist co-pay is applicable if the claim in not considered preventative. We will submit the claim on your behalf. Once we receive your explanation of benefits back from your insurance provider, we will invoice you with any patient responsibility.
Do I need a referral?
Be sure to ask your insurance company if a referral is required in order to see a dietitian. If required, you can request a referral from your doctor and have it faxed to us at 833-875-6792. We must have the referral BEFORE the appointment in order for your visit to be covered. *Please note, we always need a referral for patients wishing us to bill Aetna or Medicare.
Be sure to ALWAYS get a reference code from any representative you speak with at your insurance company. This helps to keep the insurance company accountable for any information they provide you with on your call.
In light of COVID-19, many insurance companies are waiving all member cost-shares. So please be sure to specify if you are scheduling a TELEHEALTH appointment so that you have the correct information.