Insurance Benefit Resource for Nutrition Services in Seattle

Insurance Benefit Resource

To verify your insurance benefits for nutrition counseling, please call the number on the back of your insurance card and ask them the questions below. Doing this will help ensure you get the most out of your benefits and avoid unwanted financial surprises.

Do I have benefits for nutritional counseling, CPT codes 97802 & 97803?
Do I have any nutrition counseling benefits covered under the preventative care portion of my plan? (ICD-10 code Z71.3)
Is a doctor’s referral required?
Is there a limit on the number of visits allowed?
Are there any restricted diagnoses?
Are telehealth visits covered?
Do I have a deductible to meet before insurance pays?
Do I have a co-pay or co-insurance?
Is Dandelion Nutrition and/or my preferred dietitian/ nutritionist a covered provider under my plan? If not, what are my out-of network nutrition benefit?

We have listed some information below regarding insurance coverage for nutrition therapy based upon our knowledge and/or experience to date with the companies. Please understand that we absolutely cannot know the details of each plan and that the information below is not a guarantee of coverage. We do not regularly check benefits for clients so it is your responsibility to know what your plan covers and what your portion of the cost is.

Aetna

PLEASE READ: As of March 2019, Aetna has changed their nutrition counseling policy without notifying providers. We are still trying to figure out what they will or will not cover. Historically, a referral has not been required but now it seems one may be helpful for coverage. If your BMI falls within the overweight or obese range, and if you have cardiovascular risk factors (hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome), please have your physician include those diagnosis codes in the referral.
Some plans do not cover telehealth, so be sure to call and ask Aetna.
Detailed information on coverage can be found in Aetna's Policy for Nutritional Counseling.
All appointments are limited to 1 hour, so initial appointments will need to be only 55 minutes, or you can pay out of pocket for the extra time of a full intake session (75-85 minutes).

Amerigroup

We no longer accept Amerigroup. However, reduced rates are available to clients with Apple Health (Medicaid) plans. Please contact us to discuss specific rates and if you qualify.

Ambetter Coordinated Care

We do not accept Ambetter Coordinated Care.
For Apple Health (Medicaid) plans: Reduced rates are available to clients with Apple Health (Medicaid) plans. Please contact us to discuss specific rates and if you qualify.
For Marketplace plans: We are an "out-of-network" provider, meaning you will be responsible for the fee at the time of our appointment and, depending on your plan, a certain amount of that may be paid back to you by your insurance company. Upon request, we can either submit the claim on your behalf or provide you with a form to send in to them for possible reimbursement.

Blue Cross Blue Shield

A doctor's referral is typically not required.
We can accept any out-of-state BCBS plans such as Anthem Blue Cross, BCBS of Illinois, BCBS Federal, etc.
Washington state telehealth laws may not apply to out of state plans.
Generally, Blue Cross Blue Shield's Federal Employee Program (FEP) covers 6 nutrition visits annually, with additional visits permitted when medically necessary.

Cigna

A doctor's referral is typically not required.
According to Cigna's Guide to Preventative Health Coverage, 3 wellness/ preventative visits are covered per year at 100%, meaning no cost to you.

Community Health Plan of Washington

We no longer accept CHPW. However, reduced rates are available to clients with Apple Health (Medicaid) plans. Please contact us to discuss specific rates and if you qualify.

First Choice Health / Moda Health / Health Net Plan of Oregon

A doctor's referral is typically not required.

Kaiser Permanente of WA (formerly Group Health Cooperative)

HMO plans require a formal referral/ prior authorization. They usually authorize 6 visits initially with re-authorization required for additional visits. Authorizations expire after 6 months. Although we will help request additional authorizations, it is the ultimately the client's responsibility to ensure proper authorization has been obtained prior to any scheduled appointments.
PPO or "Options" plans do not require a referral or prior authorization to see us.
Some plans have a different copay amount due for primary care visits vs. specialist visits. In most cases, KP considers us specialists.

Medicare

Medicare clients may only see RDNs... Medicare does not cover Certified Nutritionists (CNs).
Nutrition therapy is ONLY covered with a diagnosis of diabetes or pre-dialysis kidney disease. Medicare does not cover pre-diabetes or any other diagnoses.
Medicare limits the amount of nutrition therapy to 3 hours for the first calendar year you received nutrition therapy, whether nutrition therapy was provided by us or another dietitian or institution. Medicare limits the amount of nutrition therapy to 2 hours for the second calendar year.
A doctor's referral is always required. Have your doctor fax it to us at (206) 866-0204. It is the client's responsibility to ensure the referral has been received prior to any scheduled appointments.
If you have coverage through a medicare advantage plan, additional diagnoses may be covered.

Molina Healthcare

We no longer accept Molina Healthcare.
For Apple Health (Medicaid) plans: Reduced rates are available to clients with Apple Health (Medicaid) plans. Please contact us to discuss specific rates and if you qualify.
For Marketplace plans: We are an "out-of-network" provider, meaning you will be responsible for the fee at the time of our appointment and, depending on your plan, a certain amount of that may be paid back to you by your insurance company. Upon request, we can either submit the claim on your behalf or provide you with a form to send in to them for possible reimbursement.

Premera / Lifewise

A doctor's referral is typically not required.
Usually very good coverage. If not treating a specific medical diagnosis, nutrition counseling may fall under your preventative health benefit which is typically covered in full by the plan, meaning no cost to you.
Diagnoses of either diabetes or eating disorders usually not subject to number of visit limits.
We are considered an in-network provider for the 2018 Marketplace plans, however it is unclear still if a referral is required since they are EPO plans. Please ask your insurance company.

Regence / Uniform / Bridgespan / Asuris / HMA

A doctor's referral is typically not required.
Usually very good coverage. If not treating a specific medical diagnosis, nutrition counseling may fall under your preventative health benefit which is typically covered in full by the plan, meaning no cost to you.
Preventive visits and diagnoses of either diabetes or eating disorders usually not subject to number of visit limits (i.e. 3 per lifetime).

United Healthcare

We do not accept UHC.
For Apple Health (Medicaid) plans: Reduced rates are available to clients with Apple Health (Medicaid) plans. Please contact us to discuss specific rates and if you qualify.
For all other UHC plans: We are an "out-of-network" provider, meaning you will be responsible for the fee at the time of our appointment and, depending on your plan, a certain amount of that may be paid back to you by your insurance company. Upon request, we can either submit the claim on your behalf or provide you with a form to send in to them for possible reimbursement.
UHC's Coverage Determination Guideline for Preventative Care Services includes information on coverage for wellness/preventative (not related to a specific medical problem) services.

Washington Apple Health (Medicaid)

We no longer accept Washington Apple Health (Medicaid). However, reduced rates are available to clients with Apple Health (Medicaid) plans. Please contact us to discuss specific rates and if you qualify.