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

• A doctor's referral is typically not required.
• 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

• Marlene is our only clinician accepting Amerigroup, and she in the process of cancelling her contract so will soon no longer be accepting Amerigroup effective 6/9/2018. Once her contract is cancelled, she will continue to see Molina clients on a self-pay basis. To make it more affordable, reduced rates are available to clients with Apple Heatlh (Medicaid) plans. Please contact us to discuss specific rates and if you qualify.
• See coverage notes for Washington Apple Health (Medicaid).​

Ambetter Coordinated Care

• See coverage notes for Washington Apple Health (Medicaid).
• 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.
• Generally Blue Cross Blue Shield Federal covers 6 nutrition visits annually, with additional visits permitted when medically necessary.
• ​In Seattle, claims are processed through Regence Blue Shield.

Cigna

• ​A doctor's referral is typically not required.
• According to Cigna's Guide to Preventative Health Coverage, 3 wellness/preventative (not related to a specific medical problem) visits are covered at 100%, meaning no cost to you.

Community Health Plan of Washington

• Marlene is our only clinician accepting CHPW, and she in the process of cancelling her contract so will soon no longer be accepting CHPW effective 5/12/2018. Once her contract is cancelled, she will continue to see CHPW clients on a self-pay basis. To make it more affordable, reduced rates are available to clients with Apple Heatlh (Medicaid) plans. Please contact us to discuss specific rates and if you qualify.
• See coverage notes for Washington Apple Health (Medicaid).​​

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

• A doctor's referral is typically not required.

Kaiser Permanente (formerly Group Health)

• HMO plans require a formal referral/ prior authorization. They usually authorize 6 visits initially with re-authroization required for additional visits when needed. Authorizations expire after 6 months. It is 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.
• Some plans have a different copay amount due for primary care visits vs. specialist visits. Nutrition appointments are considered "specialist visits" when treating a health condition, and "primary care visits" when preventative.​

Medicare

• Medicare clients may only see RDNs... Medicare does not cover Certified Nutritionists (CNs).
  
• 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.
  
• Nutrition therapy covered only with a diagnosis of diabetes or pre-dialysis kidney disease. They do not cover pre-diabetes or any other diagnosis. 
• 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 myself or another dietitian or institution. Medicare limits the amount of nutrition therapy to 2 hours for the second calendar year.
• If you have coverage through a medicare advantage plan, additional diagnoses may be covered.

Molina Healthcare

• Marlene is our only clinician accepting Molina, and she in the process of cancelling her contract so will soon no longer be accepting Molina effective 5/3/2018. Once her contract is cancelled, she will continue to see Molina clients on a self-pay basis. To make it more affordable, reduced rates are available to clients with Apple Heatlh (Medicaid) plans. Please contact us to discuss specific rates and if you qualify.
• For Apple Health plans:  See coverage notes for Washington Apple Health (Medicaid).
• For marketplace plans:  General nutrition counseling is covered at 100% by the plan under the preventive health benefit.

MultiPlan / PHCS / PHCS Savility

• If your card has one of these logos on it in addition to another (such as United Healthcare), we may​ be covered as an in-network provider. Contact your insurance company to find out.

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

• United Healthcare does not contract with dietitians in private practice.
• 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, I can either submit the claim on your behalf or provide you with a form to send in to them for possible reimbursement.
• See coverage notes for Washington Apple Health (Medicaid).
• 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)

• Marlene is our only clinician accepting Medicaid, and she in the process of cancelling her contracts so will soon no longer be accepting Medicaid. Once her contract is cancelled, she will continue to see clients on a self-pay basis. To make it more affordable, reduced rates are available to clients with Apple Heatlh (Medicaid) plans. Please contact us to discuss specific rates and if you qualify.
• A doctor's referral is always required. Have your doctor fax it to (206) 866-0204.  It is the client's responsibility to ensure the referral has been received prior to any scheduled appointments.
• Nutrition therapy for ages 20 years and under is covered when addressing a nutrition-related problem.
• Nutrition therapy for ages 21+ is not covered. However for clients in this scenario, the reduced fee discussed above is available.