In the event your claim is denied or you schedule knowing you are not covered, initial appointments are 60 minutes for $185, and follow-ups are 45 minutes for $115.

Please note it is your responsibility to call your insurance company PRIOR to the visit to confirm coverage. I know I sound like a broken record – I just don’t want my patients to have ANY surprise bills.
Questions: 

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. 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 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. 

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 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. 

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, utilizing your preventative benefits, if your plan allows. With that being said, if you have preventive benefits, there is often no cost share associated with the visit. Once again, this is something YOU do want to ask before your visit. 

If you have a cost-share, we will initially bill your insurance company directly.  Once we receive the EOB 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 specialists. Therefore, your specialist co-pay is applicable and must be paid at the time of service. This information is often apparent on the front of your actual insurance card. However, because we bill your insurance for preventative counseling (or try to), 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 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 Licensed 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 additional cost for me if I choose to have the appointment as a telehealth visit versus an in-person visit?