Before your first session:

 

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We are currently in network with BlueCross BlueShield (BCBS) and United Health Care (UHC). It is recommended to verify your insurance benefits before your first session as your coverage could have specific qualifications. Your specific policy could also have limitations and exceptions. Coverage details are for primary insurance providers. The following information is based on our experience with billing for these insurance companies and is intended to provide guidance, not certainty: 

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• Most BCBS PPO plans often cover 100% of visits with no deductible requirements, no co-pay, and no maximum visits -- it is at no extra cost to you! In our personal experience, labor union plans and some out-of-state BCBS plans do not typically cover preventative nutrition services -- Some labor union plans usually cover nutrition counseling with nutrition-related diagnosis (obesity, diabetes, CKD, etc). If a diagnosis is required for coverage of appointments, please contact your primary care physician for a referral to provide evidence of your BMI or related diagnoses for coverage of appointments BEFORE your first session.

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• UHC plans often cover 100% of visits with no deductible requirements, no co-pay, and no maximum visits IF you have a Body Mass Index (BMI) of 30+, OR a BMI of 25+ with a cardiovascular or diabetes related diagnosis. Some UHC plans provide full coverage with a BMI of 25-29.9 without a diagnosis, but this is policy dependent. Policies of your specific UHC plan heavily dictate what diagnoses are covered and limitation of visits. UMR plans are under UHC, however UMR has not been successful for coverage of sessions in our experience. It is highly recommended to contact your representative to find out more about your policies coverage for nutrition counseling. If a BMI code or diagnosis code is needed, a referral from your primary care physician is needed to provide evidence of your BMI or related diagnoses for coverage of appointments BEFORE your first session.​

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If using insurance for coverage of visits, claims will be billed to your insurance company. In the event that coverage is not met, or a co-pay is needed, you will be invoiced and charged to the payment method on file. Any payments that are rejected or insufficiently funded will be the client's responsibility to cover within 30 days of receiving written notice. We also accept HSA/FSA and credit/debit cards as acceptable forms of payment. Although these insurances are accepted, your coverage details may have limitations or specifications for nutrition care. Please see below for the questions to ask your insurance representative BEFORE your first appointment, as you will be responsible for any fees not covered by insurance. Wholesome Nutrition LLC does its best to supply you with the necessary information to verify your benefits with your insurance company. It is in your best interest to contact your insurance carrier to understand your coverage. Additionally, Wholesome Nutrition LLC will work diligently to dispute any denied claims and advocate for your insurance coverage. 

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If your insurance plan is considered out-of-network, we can provide a monthly superbill that you can submit to your insurance company. When submitting a superbill, there is no guarantee that your insurance will cover the visits. You would still be responsible for your visits whether or not they end up being covered. Please see below for the questions to ask your insurance representative BEFORE making an appointment, as you will be responsible for any fees not covered by insurance.

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Questions for Insurance Company

 

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1. Ask the representative if preventative nutrition counseling or medical nutrition therapy is covered under your insurance.

If yes, please ask them if the following CPT codes are covered: 97802 (initial appointment) & 97803 (follow-up appointments). If they say you do not have coverage using those codes, NEXT ask them to check your coverage for the following CPT codes: 99401 through 99404.

Ask the representative if the following diagnostic code, also known as an ICD 10 code is covered: Z71.3 for medical nutrition therapy/ nutritional counseling. We always try to code your visit using this preventative coding to maximize the number of visits you receive from your insurance carrier. If not, ask what diagnoses or diagnostic codes are covered under your plan (cardiovascular, diabetes, obesity, etc). If you have one of the diagnoses, we will need a direct referral from your doctor with the applicable ICD 10 code for that diagnosis.

 

2. Ask if there is a referral needed or if a specific diagnosis is needed on your PCP referral.

If a referral is needed, be sure to ask your insurance company if there are specific diagnoses (overweight, obesity, diabetes, high blood pressure, etc) that are required in order to have coverage for sessions. You can request a referral from your doctor and have it faxed to us at 815-277-1279. We must have the referral BEFORE your first appointment in order for your visits to be covered.

 

3. Ask if Telehealth visits are covered.

Many plans have extended coverage to include Telehealth, specifically for preventative health services. Even if other medical appointments aren't covered via Telehealth, preventative health appointments still can be covered, they are separate. Please check with your rep.

 

4. Ask how many visits you have that are covered per calendar year, or if there is a maximum number of visits allowed.

Your carrier will let you know how many visits or units they are willing to cover. Depending on the carrier, the number of visits varies from 0 to unlimited depending on medical needs and diagnoses.

 

5. Ask if there is a deductible.

Often, preventative services do not require you to meet your deductible for coverage of sessions. However, your policy may state a deductible has to be met before the insurance company will pay. If you haven't met that deductible, you may have to pay out-of-pocket until you meet your deductible. We will provide you with the appropriate documentation to submit to your insurance company to show receipt of the services. This will allow you to “pay down” your deductible. Once your deductible has been met and you have nutrition services on your policy, I can then directly bill your insurance company.

 

6. Ask if you have a co-pay for nutritional counseling.

For Telehealth visits and preventative counseling, there is rarely ever a co-pay for services. However, if your policy dictates that dietitians are specialists, there could be a specialist co-pay applicable if the claim is not considered preventative (the Z-Codes listed above). We will submit the claim and will invoice you with any patient responsibility if needed.

 

7. Be sure to ALWAYS get a reference code for your conversation with that representative you speak with at your insurance company.

This helps to keep the insurance company accountable for any information they provide you with on your call, especially in the event that coverage is denied.