Insurance
Do you Want to Use Insurance for your Nutrition Visits?
In most cases you CAN use insurance for your nutrition appointments.
We accept most insurance plans and many of our clients pay $0.00 for appointments!
What Insurance Companies Do we Participate With?
At the present time, Susan Carroll is an in-network provider for most commercial insurance plans including Blue Cross Blue Shield, Cigna, Harvard Pilgrim, Mass General Brigham, United Health Care, Aetna, Tufts commercial plans (We do not accept MassHealth or Tufts Public/Direct plans), Medicare (coverage only for a diagnosis of diabetes or chronic kidney disease. Medicare does not cover nutrition for prediabetes, overweight or other diagnoses).
Most health insurance companies cover nutrition counseling, although you (not us) need to call to verify and confirm that you do have benefits on your policy for nutritional counseling
If we are out-of-network with your insurance, sessions may still be covered. We can provide you with a superbill to submit yourself for possible reimbursement. Payment is due from you at the time of service.
Verifying your Benefits and What to Ask when you Call
Start by calling the 800 number on the back of your insurance card and ask to speak to a representative. See below for what questions to ask your insurance company PRIOR to your visit.
Make sure that you have a pen and paper available to write down any and all details. Also, make sure that you write down the reference number for the call.
Do I have nutrition 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?
Ask if you have a fully funded plan (fully funded plans, under the ACA act, must cover preventative services) and about these codes which are often considered preventive and may waive your co-pay and deductible:
- If the representative asks for a diagnosis code (aka ICD 10 code) – please tell them 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 is often NO cost share to you for 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, if the visit is not applied to your preventive benefits, 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?
- Have I met my deductible?
Ready to get started?
