Using Insurance for Your Nutrition Visit

Are you curious about how insurance works when booking a visit with a Registered Dietitian-Nutritionist?

Let's break it down!

Does insurance cover nutrition counseling? You bet, it does!

Most health insurance plans include coverage for nutritional counseling, meaning you can use your insurance for your nutrition visits. However, you need to confirm your benefits first! Call your insurance company to check if your policy covers nutrition counseling - even if you don't have a specific diagnosis. Many policies cover preventive services, too.

Please call the 800 number on the back of your insurance card and ask to speak with a representative to confirm your coverage. The steps below will guide you through verifying whether nutrition counseling is covered under your plan.

One last reminder: Confirm your benefits before booking your visit. We're all about keeping things simple and stress-free, and we want to avoid surprise bills!

What insurance companies are we in-network with?

Currently, Hescott Nutrition Services is a preferred provider with Aetna, Cigna, Healthfirst Medicare, and United Healthcare. Please note: Medicare covers nutrition visits only if you have diabetes or renal disease. Unfortunately, Medicare does not currently cover nutritional counseling for pre-diabetes or obesity in an outpatient setting.

What if you're not in-network with my insurance?

We currently participate with all major insurance companies, so if your plan includes benefits for nutrition counseling, you can likely use insurance for your visit.

However, keep in mind that not all insurance plans cover nutrition services. To avoid surprises, please call your insurance company before scheduling to confirm that nutrition visits are covered under your plan. Refer to the guide below, "What questions should I ask when calling my insurance?"

If your claim is denied due to lack of nutrition coverage, our rates are $220 for initial visits (60 minutes). Hescott Nutrition Services accepts all major credit cards.

What questions should I ask when contacting my insurance company?

Please remember that it's the client's responsibility to call their insurance company before your visit to confirm coverage. We know we sound repetitive, but we want to help you avoid any surprise bills!

Here are the key questions to ask:

1. Do I have nutritional counseling coverage?
   • If the representative asks for a CPT code, provide these: 97802 and 97803.
   • If they don't cover these, ask them to check codes 99401, 99402, 99403, and 99404.
   • We can also bill with S9470 if your policy allows.
2. Will my diagnosis be covered?
   • For a diagnosis code (ICD-10), use: Z71.3.
   • If they don't accept Z71.3, try Z72.4 instead.
   • If you're overweight, obese, have pre-diabetes, diabetes, hypertension, or high cholesterol, check if these diagnoses are covered under your plan.
   • We use preventive coding when possible to maximize your covered visits. However, if you only have a medical diagnosis (e.g., IBS without obesity or cardiovascular risk factors), your insurance may require a deductible, co-pay, or co-insurance.
3. How many visits am I covered for each year?
   • Ask your carrier how many visits they cover annually. This can range from none to unlimited, based on medical necessity.
4. Do I have a cost-share for my nutrition visit?
   A cost-share is the portion you're responsible for paying under your insurance plan, which may be a deductible, co-pay, or co-insurance. We will bill your visit under your plan's preventive benefits if applicable, as preventive visits often have no cost-share. That said, this is something you'll want to confirm with your insurance before your visit.
   
   If a cost-share applies, we will first bill your insurance directly. After we receive the Explanation of Benefits (EOB), detailing any patient responsibility, we’ll provide you with an invoice and bill the card on file for the specified amount.
   
   Since most insurance plans consider dietitians specialists, a specialist co-pay may apply, which is often listed on the front of your insurance card. However, with preventive counseling, a co-pay is frequently not required. We usually wait for the claim to process to confirm if a co-pay is needed, then we'll charge your card on file for the applicable amount.

Summary of questions to ask your insurance to verify nutrition benefits:

1. Do I have coverage for nutrition counseling?
2. Do I need a referral to see a Registered Dietitian?
3. Are my diagnoses covered under my plan?
4. How many visits am I covered for per calendar year?
5. Is there a cost-share for these services?
6. Is there a different cost for telehealth visit?

If you have questions after verifying your benefits, we're here to help! CONTACT US, and you will receive a response within 48 business hours.