1. 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. 

2. Do I need a referral or a prior authorization?
If you need a referral or a prior authorization, it is your responsibility to obtain these documents and either upload them when scheduling your appointment or fax them to the fax number provided when scheduling.

3. 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, as these are often covered under preventative care and have no copy or cost share.
  
• If you ONLY have a medical diagnosis (for example: IBS, and you are not overweight or have cardiovascular disease risk factors) your insurance may impose a cost-share for your visit either in the form of a deductible, co-pay or co-insurance. 

4. 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.

5. Do I have a cost-share for my nutrition visit?
A cost-share is the amount your insurance plan requires you to pay towards services. A cost-share can be in the form of a deductible, co-pay, or co-insurance. 

If you have a covered diagnosis for 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. 

We will not collect your cost-share at the time of your visit. First, we will bill your insurance company directly.  Once we receive the explanation of benefits (EOB) describing your responsibility as the patient, we will bill the credit card on file for the amount noted under “patient responsibility”. If your cost-share is a copay, you can expect to be billed your specialist copay.

6. 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 an in-person visit?