Insurance FAQs for Nutrition Counseling: Coverage, Costs & How to Use Your Benefits

Admin
Nov 10
3 min read

Updated: Nov 12

Keep reading for FAQ's about insurance coverage for nutrition counseling:

Do you verify insurance coverage?

Both dietitians at Hleap Nutrition are in network with all major insurance plans in PA and NJ. Only Claudia is in network with certain insurance plans in NY (Cigna, Aetna, Emblem). In order to verify insurance coverage for nutrition counseling, you can call your insurance company (you can find the number on the back of your insurance card) and use the insurance guide (linked here), which contains all the questions to ask your insurance so that they can confirm for you whether your specific plan covers nutrition counseling. Most do!

Nutrition counseling is almost always covered as a preventative service. This means that it is typically covered at no cost to you with no copay or deductible requirement!

If this is not covered by my insurance, how much will a session cost?

The cost of a 1-hour session depends on the provider you work with:

Claudia Hleap-Knight = $180 / hour

Kate Carickhoff = $100 / hour

Can I use HSA/FSA to pay for out-of-pocket costs?

Yes! You can provide us with your HSA/FSA card to use for out-of-pocket nutrition counseling costs.

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

Claudia and Kate are both 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.

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

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:

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:

What is covered under Medicare Part B insurance?

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.

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
Fax this new script to 215-709-7699

If you have a Medicare supplemental plan or Medicare Advantage plan, you will need to use our Insurance Guide, linked HERE (or attached above as "Instructions for Verifying Insurance Benefits") if you want to verify coverage prior to your appointment.

What about copays and/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.

How much does nutrition counseling cost if this is not covered by my insurance? How much do you charge/hour?

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

Kate's out-of-pocket hourly rate is $100/hour

If you would like a more affordable option, consider signing up for our Nutrition 101 course. This 1 hour self-paced course is $50 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 linked HERE.