Insurance Coverage & Verification

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Aetna
In-network, generally covered 100% for 10 visits, some have up to 26 per year.
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Blue Cross Blue Shield/Anthem
In-network, generally covered 100% - most get unlimited visits. 
Referral required for HMO & Medicare.

Cigna
Out of network, generally applies to deductible or clients see coverage with a copay due.
No referrals required.

Friday
In-network,  generally covered 100%.
No referrals required.

Humana
In-network, generally covered 100% for 3 hours per year.
Referral required for HMO & Medicare. 

Medicare
  In-network, only covers diabetes (type 2) and chronic kidney disease. 
Referral required.

Molina Health
In network, generally coverage at 100%, no visit limit.
Referral not required. 
 
United Healthcare/UMR
In-network, generally covered at 100%, some plans have limits, exclusions to sessions or medical conditions.
Referral not required. 

Sana
In-network

Superior Health (Ambetter)
In-network, generally covered at 100% with unlimited visits. 
Documentation of medical condition or referral required. 

Tricare
Not in-network, we have seen coverage for some patients.
Referral required.

Wellcare
​In-network, only covers Diabetes (Type 2) and Chronic Kidney disease.
Referral Required. 

NO COVERAGE?
With minimal proof of medical need and financial hardship, we do offer a limited number of slots using a pay what you can afford model for sessions with a dietitian.

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HMO Plans

HMO plans must have a referral from your primary care physician faxed to us prior to our session in order to bill your insurance. 
If we are out of network and nutrition counseling is critical to success and management of your condition there may be an opportunity for you, us, and your physician to collaborate to file an appeal/preauthorization to request coverage for your medical condition.

How To Verify Your Insurance Coverage

Call the Member Services Number on the Back of your Insurance Card and provide them with the information below:
​We suggest you record the date, time and name of the representative and keep this information for your records.

Does my insurance cover nutrition counseling?
​Provide the following procedure code:
97802 - Procedure code for an initial nutrition counseling appointment
97803 - Procedure code for a follow-up nutrition counseling appointment

Will my plan cover nutrition counseling for (your health conditions)?
Provide an ICD-10 diagnostic code: Z71.3  (the most common).  
List of other common ICD-10 Codes for medical conditions that may be needed. 

Additional Questions to ask:
Do I have a deductible to meet first? □ Yes □ No         If yes, how much?______________
Do I have a co-pay or co-insurance? □ Yes □ No          If yes, how much? _____________
Do I have a limited number of visits? □ Yes □ No 
If yes, how many per benefit year? _______ & when does the benefit year start? ___________
Do I need a physician referral? □ Yes □ No
Does my plan cover telehealth □ Yes □ No
Will my plan cover nutritional counseling as part of my preventative health services under the Affordable Care Act or Health Care Reform? □ Yes □ No
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ONLY IF PROVIDER IS OUT OF NETWORK, YOU SHOULD ASK THE FOLLOWING QUESTIONS:
Does my plan has coverage for Out of Network benefits? □ Yes □ No
Does my plan reimburse if I submit a superbill?  □ Yes □ No
If yes to either questions, ask all of the in network questions above to inquire about your out-of-network benefit coverages.