Health Insurance for Nutrition Services
Your insurance policy may cover the visits.
Why not check to see if your insurance policy will cover the visits? Start by calling the 800 number on the back of your insurance card and ask to speak with a representative.
The information below will walk you through the steps to take to see if your insurance will cover the cost of nutrition counseling for your visit.
What insurance companies does Amy and her team (The Plano Program) participate with?
At the present time, Amy and her entire team are preferred providers with Aetna, Medicare, Cigna, Connecticare, Harvard Pilgrim Health Care, United HealthCare and Anthem Blue Cross and Blue Shield. Medicare only covers the visit if you have diabetes or renal disease. Medicare DOES NOT cover for nutritional counseling for pre-diabetes at this time.
I live far away, can I use my insurance for telehealth services with Amy and her team?
Right now (2022) due to the pandemic most insurances are covering for telehealth services. Therefore, when you schedule your visit you will be directed towards the next steps to setting up properly for your telehealth session. However, it is possible your insurance plan may impose a cost-share for you to use this service. Therefore, please call your insurance company to confirm your telehealth coverage PRIOR to scheduling your visit.
With that being said, if you prefer to be in-person at our 500 Boston Post Office we are happy to accommodate your request. All in person visits are conducted by the fabulous Audrey Castell-Watts on Thursdays and Saturdays. Therefore, if prefer to be seen in person schedule with Audrey on either a Thursday or Saturday. She will reach out within 48 hours to confirm this visit.
What happens if you do not participate with my insurance?
Currently, Amy and her team participate with all the major insurance companies.
However, that does not MEAN all insurances cover nutrition. Therefore, you are required to call your insurance company prior to scheduling your visit to confirm your nutrition visits will be covered. Please follow the steps below ‘What questions should I ask when calling my insurance?’
In the event, your claim is denied for lack of nutrition coverage our initial visits (60-minutes) are $180.00 and each follow-up visit (30-minutes) is $80.00. The Plano Program accepts cash, check and all major credit cards.
What questions should I ask when calling my insurance company?
Please note it is the patient’s responsibility to call their insurance company PRIOR to your visit to confirm coverage. I know we sound like a broken record – we just don’t want our patients to have ANY surprise bills.
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 vary 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 if 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 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, often because 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 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 Michele Ramos @ firstname.lastname@example.org. She will return your message within 48 business hours.