Does Insurance Cover Dietitians?
Maintaining a healthy diet is a cornerstone of overall well-being, but sometimes, we need a little extra guidance to make the right choices. That's where Dietitian (like me!) come in. I’m not going to lie- sometimes, the cost of paying out-of-pocket for a Dietitian, including myself, can often be cost prohibitive. While I do my best to balance my needs as a small business while also trying to make services accessible, like providing bundle discounts, accepting HSA/FSA, providing sliding scale fees, and some pro bono services; affordability is always a concern. The good news is that dietitian services (even for out-of-network providers) may be covered by insurance!
The extent of your coverage can vary depending on several factors, including your specific insurance plan, your specific health needs, and the regulations in your state. For example, some plans only cover in-network dietitians, while others cover out-of-network dietitians but will reimburse you with a superbill. Some will cover dietitians but only with a physician referral, while others don’t require a referral. It can be confusing to know your coverage! That’s why I have a handy-dandy list of questions to ask your insurance provider if you want to work with me, and want to see if your insurance will cover services.
In most cases where individuals use insurance with me, the process looks like this: you FIRST confirm coverage with these questions, then we have your first appointment where you pay out of pocket, and then I will create a superbill for you. This is a specific form that plans request you submit for reimbursement. Typically, you will receive reimbursement within a month, but that varies by company. People will often wait for that first reimbursement to process before booking follow-up appointments, just to make sure everything looks okay for reducing out-of-pocket costs.
So if you are looking to use insurance for my services, here is your list of questions to have when you call your insurance provider. Make sure to write the answers down, and get a reference number for your phone call! And when you’re ready, schedule your first appointment with me!
Questions to ask your insurance provider to assess out-of-network Dietitian service coverage:
1. Are dietitian services covered for out-of-network providers for my plan?
2. For out-of-network dietitians, will a superbill be accepted for reimbursement?
2. Does my plan cover outpatient nutrition therapy CPT codes 97802 (medical nutrition therapy assessment), 97803 (medical nutrition therapy follow-up), or S9470 (nutritional counseling)?
3. Do I have any nutrition counseling visits covered under the preventative care portion of my plan (ICD-10 code z71.3)? If so, how many?
4. Due to the COVID-19 pandemic, do I currently have coverage for services provided via telehealth?
5. Do I need a physician referral for nutrition counseling? If yes, is there a specific form you provide or that needs to be submitted along with a superbill for reimbursement?
6. Do I have a deductible for nutrition counseling services? If so, how much is it and how much has been met so far?
7. Is there a copayment for each visit?
8. Is there co-insurance for each visit? If yes, what is the percentage of coverage?
9. What month does my policy year renew?
10. Are there any restrictions and/or limitations to my coverage?
Whew, okay I know that’s a lot of questions- BUT, we want to make sure you have your bases covered when it comes to checking your benefits, since you are responsible for out-of-pocket costs even if a superbill is not accepted. Need more help checking if your insurance covers my Dietitian services? Please reach out- I’m happy to help!
-Meghan
