​Where to Start:

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• Call your insurance's customer service number, which can be found on the back of your Policy ID card

• Navigate the automated phone system to reach an advocate, inform them you are calling for Eligibility and Benefits

• Many insurance advocates are known to give the least information necessary to answer questions. Please ask for clarification or additional questions to understand your policy. MAKE THEM EXPLAIN your nutrition benefits. 

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Questions to Ask: 

 

1. Do I have nutritional counseling coverage on my insurance plan?

 

• If the insurance company asks for a CPT code (medical service code), please provide the following codes 97802, 97803, and S9470, if not ask for 99401, 99402, 99403, 99404

 

• Follow up by stating that your visits will be billed for preventative care. Otherwise, they may quote you for medical benefits, which are typically NOT covered unless you have a specific diagnosis

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​    2. Will my diagnosis be covered?

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• If the representative asks for diagnosis code (ICD 10 code), please use Z71.3

• If Z71.3 is not accepted, then provide them with Z72.4, and see if it is covered.

• Check to see if there is coverage for the diagnoses listed in your referral.

• If you are overweight, obese, have high blood pressure, high cholesterol, pre-diabetes, or diabetes, you can ask 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 (such as diabetes and no CVD risk factor), your insurance may impose a cost-share for your visits as a deductible, co-pay, or co-insurance.

 

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3. How many visits do I have per calendar year?

 

• Your carrier will let you know how many visits they cover. Depending on the policy, the number of visits varies from O to unlimited visits, depending on medical necessity.

 

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Summary:

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1. Do I have coverage for nutrition counseling, when billed under preventative care?

2. Do I need a referral from my Primary Care Physician to see a Registered Dietitian? (for example, HMO plans) If so you will need a prior authorization or will need to ask your PCP to fax a referral to our office (972) 767-3583

3. Does my particular plan cover any of my diagnoses?

4. How many visits per calendar year do I receive?

5. Do I have a cost-share (co-pay, co-ins, or deductible requirement) for these services?

 

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DISCLAIMER:

 

Patients are responsible for verifying their insurance for nutrition services prior to their visit. By booking an appointment, you have agreed to full financial responsibility of $90 for your visit if your insurance does not cover your nutrition appointment. The fee is due at the time of the visit and charged to the card on file. Please be advised that we have a 24-hour cancellation policy, and there will be a $25.00 fee for canceling visits with less than 24 hours' notice.