Insurance Coverage for Nutrition Counseling

Which providers can I see in Philadelphia, PA and which provider can I see in New York? Are they in-network with my insurance?

 

Claudia, Jess, and Kate are all in-network providers with all major insurance companies in Philadelphia, PA.

*** Only Claudia is in network with plans in New York state (specifically Cigna, Emblem GHI, and Aetna). She is NOT in network with other insurance companies, but this does not mean that it will not be covered by your insurance! You can still call them to determine out-of-network benefits.

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How can I find out what is covered by my insurance plan?

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Each insurance plan has varying degrees of coverage. If you would like to confirm insurance coverage prior to your appointment, call your insurance company using the phone number on the back of your insurance card and ask the following questions on this form to clarify your coverage. Make sure to bring this form to your appointment: INSURANCE COVERAGE
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If your insurance plan requires a referral from your Primary Care Physician in order for your appointment to be covered, you can use this form as a guide for your referral. Your PCP will need the codes on this form in order to write the referral correctly. All required information is listed on this guide: ​REFERRAL FORM​

 

What about copays or deductibles?

 

Plan to pay any copays or deductible that applies for your plan. If an insurance claim is denied it is your responsibility to pay any remaining balance in full. A copay is a set amount that you need to pay to see a specialist (if we're not able to cover this service as preventative under your insurance plan) A deductible is a minimum that you need to spend towards your health care costs before your insurance coverage will kick in. The value of the deductible varies from plan to plan.​

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How much does nutrition cousneling cost if it's not covered by my insurance? How much do you charge per hour?

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Claudia's out-of-pocket hourly rate is $180/hour

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Jess and Kate's out-of-pocket hourly rate is $100/hourWe do accept HSA/FSA cards for out-of-pocket costs.​

 

If you would like a more affordable option, consider signing up for our Nutrition 101 course. This 1 hour self-paced course is $35 and covers the fundamentals of nutrition and the top tips we provide our patients with in their first 1-2 sessions with us. This course is not going to be individualized to your specific needs and medical history, but it's a great place to start if you'll need to pay out-of-pocket for appointments.​

 

More information on our Nutrition 101 course here.

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Insurance Coverage for Nutrition Counseling by Plan:

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Medicare Part B

 

Medicare Part B will only cover nutrition counseling for Diabetes and/or non-dialysis Kidney Disease. Patients with these diagnoses are covered at 100% with a script from a physician and qualifying bloodwork. Coverage includes 3 hours in the first year for MNT and 2 hours per year in follow-up sessions.

BUT, once you've exhausted these codes, if there has been any change or obstacle with your diagnosis and treatment plan, your doctor can write a new script including "change in status" with CPT code G0270 and you'll be able to get unlimited visits for the rest of the calendar year!

If you have a Medicare supplemental plan or Medicare Advantage plan, you will need to use our Insurance Guide, HERE if you want to verify coverage prior to your appointment. 

 

Independence Blue Cross (Personal Choice, Keystone Health Plan East, FEP)

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6 visits/calendar year, $0 cost to you. Keystone Health Plan East typically requires a referral from your PCP for coverage. Referral information linked here. 

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IBX policy for nutrition counseling

FEP policy for nutrition counseling

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Aetna

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Usually 10+ visits, depending on BMI (if BMI >25). Without this BMI, another diagnosis code may be needed. With a diagnosis of diabetes you may be covered for up to 26 sessions/year with a registered dietitian.

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Aetna policy for nutrition counseling linked

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Cigna​

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With Cigna you should get a minimum of 3 visits per benefit period, but some plans cover unlimited visits!

 

United Health Care (UHC)​

 

Coverage for UHC varies by plan, but is almost always covered with a diagnosis code of BMI >25 +/- another code

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Horizon BCBS of NJ

 

Usually covers at least 3 sessions per year, sometimes requires a co-pay. Use our insurance guide to verify coverage.​​

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Highmark Blue Cross Blue Sheild​

 

Usually covers at least 6 visit/year. Some plans offer unlimited limits and other require a copay, this depends on each individual plan. 

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