Insurance

Questions to ask when calling your insurance company

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.

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 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.  

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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. 

Things to note:

• We will always bill under your insurance policy’s plan under your preventative benefits to minimize cost to you.

• 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”.

• We generally wait for the claim to be processed to determine whether or not you have a co-pay, and then charge the co-pay amount to the credit card you have on file with us.