Rates & Health Insurance for Nutrition Counseling in Seattle

Rates & Health Insurance

Most health insurance plans cover nutrition visits with us, often at NO COST to you.
Telehealth is covered by the far majority of plans we accept, especially during COVID-19.

DANDELION NUTRITION ACCEPTS:

Aetna - Physician order/ referral required; please read coverage details below
Blue Cross Blue Shield
Cigna
First Choice Health
Kaiser Permanente (referral + authorization required for HMO plans)
Medicare - Referral required; please read coverage details below
Premera Blue Cross / Lifewise (NOT Medicare Advantage Plans)
Regence Blue Shield / Uniform / HMA / Asuris

Coverage varies greatly between plans. Please scroll down for help determining what your plan covers. If insurance declines to cover your visit(s) for any reason, you are responsible for the full amount billed.

If we are out-of-network with your insurance, sessions may still be covered. Upon request, we can either send a claim to your insurance on your behalf or provide you with a superbill to submit yourself for possible reimbursement. Payment is due from you at the time of service.

PAYMENT:
We accept cash, check, credit/debit cards, HSA & FSA cards.
A credit/debit card on file is required to secure appointments.

Nutrition Counseling	Standard Rates (billed to insurance)	When Paid at the Time of Service
Initial Nutrition Assessment - up to 85 min standard / up to 55 min Aetna clients only* *Aetna only covers up to 1 hour for all appointments. Clients preferring the usual longer initial appointment may pay $60 out of pocket for the added time not covered by Aetna.	$285 / $190	$225
Nutrition Follow-up - up to 55 min	$160	$140
Other Services (for established clients) i.e. nutritional analysis, letter writing, care conferences, phone or email check-ins taking >5 minutes, etc.	-	$140 /hr prorated in 15 min increments
*Cut to the Chase Food Sensitivity Program (MRT+LEAP)** *MRT+LEAP is only available to clients enrolled in our 12 week all inclusive food sensitivity program	-	Book a mini consult call to discuss

We offer reduced rates to clients with Washington Apple Health (Medicaid) plans. Please contact us to discuss rates and eligibility.

BEFORE YOUR VISIT, PLEASE CALL YOUR INSURANCE COMPANY AND ASK:

Is nutrition counseling covered? (the procedure codes are 97802 and 97803)
Are there restrictions on which diagnoses are covered?
Is Z71.3 (dietary counseling and surveillance) covered, or is a medical diagnosis required*?
*If a medical diagnosis is required, have your doctor fax recent visit notes and your diagnosis list to us at 206-866-0204.
Do I need a referral or prior authorization?
Is nutrition counseling covered when provided via telehealth?
How many visits are allowed?
Do I have a deductible to meet before insurance pays? If so, is the deductible waived for preventive nutrition therapy?
Will I have a copay or coinsurance?
Is Dandelion Nutrition (NPI 1285046292) covered under my plan? If not, what are my out-of network nutrition benefits?
Write down the date and reference number for your call.

Doing this will help ensure you get the most out of your benefits and avoid financial surprises!

NOTES ABOUT EACH INSURANCE COMPANY:
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.

COMPANIES WE ACCEPT:

Aetna

Coverage with Aetna is tricky as they have very specific requirements. Please read this thoroughly and contact us if you have any questions.

We must receive a physician's referral/ order prior to your visit in order to bill your insurance. Have them fax it to us at 206-866-0204 along with your full diagnosis list and any relevant clinical notes & labs. It's common for reps to say a referral is not required, however Aetna's Nutritional Counseling Policy clearly states that nutrition counseling is covered "when it is prescribed by a physician", even for preventive nutrition counseling (a.k.a. "healthy diet counseling").
If we don't have a physician referral/ order and diagnosis code to bill with, you will need to self-pay at the time of service.
Covered diagnoses:
- "Obesity" or a z-code for BMI of 30+ counts as preventive
- "Overweight" (or a z-code for BMI of 25-29.9) PLUS a cardiovascular risk factor (I.e. hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome) counts as preventive
- For children, BMI >85th %ile counts as preventive
- Most other medical diagnoses are covered with the exception of ADHD, asthma, chronic fatigue, and Z71.3 "dietary counseling and surveillance". Deductible/ copay may apply.
Historically, not all Aetna plans have covered telehealth, however during COVID-19 they have.
All appointments are limited to 55 minutes. We usually need 85 minutes for initial appointments so recommend self-paying for the additional time. If you would prefer to just have a 55 minute initial we can do that but may not have enough time to cover everything.
Self-funded plans and "trusts" make their own rules. VERY important to check benefits in advance for these plans.
We are in-network with Aetna's Medicare Advantage Plans.
- Aetna Medicare HMO plans only cover DM and CKD and have all the same rules as straight Medicare. See our "Medicare" section below for more information.

Feel free to send a picture of your insurance card(s) to billing [at] DandelionNutrition [dot] com and we'll let you know if we identify any issues with coverage. Doing this is NOT a replacement for calling your insurance and asking the questions listed higher up on this page.

BLUE CROSS BLUE SHIELD

We are considered in-network for out-of-state BCBS PPO plans (i.e. Anthem Blue Cross, BCBS of Illinois, BCBS Federal, etc.)
There are countless different BCBS plans throughout the country and they each have their nuances about what is or is not covered and the requirements for coverage.
While we ALWAYS recommend calling your Insurance to check benefits for nutrition counseling, it is especially important with these plans.
A doctor's referral is typically not required.
Historically, we have occasionally encountered BCBS plans that don't cover telehealth, however during COVID-19 they all have been.
Self-funded plans and "trusts" make their own rules. VERY important to check benefits in advance for these plans.

CIGNA

A doctor's referral is typically not required.
At least 3 wellness/ preventative visits are covered per year at 100%, meaning no cost to you. Additional visits are covered by most plans, though sometimes with a copay/coinsurance.
Telehealth is covered same as in-person.
Cigna's Preventative Care Services Policy
Self-funded plans and "trusts" make their own rules. VERY important to check benefits in advance for these plans.

FIRST CHOICE HEALTH

A doctor's referral is typically not required.
Most plans cover visits in full, however some do require a copay/ coinsurance.
Telehealth is usually covered same as in person.
Self-funded plans and "trusts" make their own rules. VERY important to check benefits in advance for these plans.

KAISER PERMANENTE OF WASHINGTON

Telehealth is covered for all plan types.
Self-funded plans and "trusts" make their own rules. VERY important to check benefits in advance for these plans.

Core HMO Plans:

Referral/ prior authorization are always required. They 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.
If we don't have a current authorization on file, you will need to self pay at the time of service.
Deductible/ copay/ coinsurance may apply.
Medicare Advantage Plans: Clients must see Registered Dietitian Nutritionists (RDNs). Certified Nutritionists (CNs) are not covered. See our "Medicare" section below for additional details. We are in-network with Kaiser's standard Medicare Advantage Plan, but NOT their Anchor Med Adv Plan.

Options PPO Plans:

Referral/ prior authorization are NOT required.
Nutrition visits are usually covered at 100%, meaning no cost to you.

MEDICARE

MEDICARE PART B

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, whether it was provided by us, another dietitian or a combination of both. Medicare limits the amount of nutrition therapy to 2 hours for subsequent calendar years. Additional visits are covered when there is a change in your condition and your doctor sends us a new referral.
A referral from your Medicare doctor (MD or DO) is always required. Have your doctor's office 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.
Telehealth is being covered during COVID-19.

MEDICARE ADVANTAGE PLANS (a.k.a. Medicare Part C)...

These are plans offered through private insurance companies like Kaiser, Aetna, etc. We bill the insurance company, not Medicare.
Medicare Advantage Plans may cover additional diagnoses that straight Medicare doesn't and may also cover more visits.
A referral is still required.
We are not in-network with Premera's Med Adv Plan.
We are in-network with Regence's PPO Med Adv Plan, but not their HMO one.
We are in-network with Kaiser's standard Medicare Advantage Plan, but NOT their Anchor Med Adv Plan.

MEDICARE SUPPLEMENT PLANS (a.k.a. MediGap)...

These plans don't provide any additional benefits beyond straight Medicare. If straight medicare won't cover it, a Medicare Supplement won't either. These plans only help cover copays, which don't apply to nutrition therapy anyway.

PREMERA / LIFEWISE

No referral required.
PPO plans almost always cover nutrition visits at 100%, meaning no cost to you.
EPO plans may be subject to your deductible/ copay/ coinsurance. 2020 individual plans are EPO's.
Telehealth is covered same as in-person.
Self-funded plans and "trusts" make their own rules. VERY important to check benefits in advance for these plans.

PREMERA MEDICARE ADVANTAGE HMO PLANS

At this time we are not in-network with Premera's Medicare Advantage Plans.
Clients with these plans will have to self-pay at the time of service and we will not bill your insurance.

REGENCE / UNIFORM / HMA / ASURIS

No referral required.
PPO plans almost always cover nutrition visits at 100%, meaning no cost to you.
Preventive visits and diagnoses of either diabetes or eating disorders are usually NOT subject to number of visit limits (i.e. 3 per lifetime). We are happy to bill nutrition visits as preventive!
Telehealth is covered same as in-person.
EPO plans consider us "out of network" because we are not part of a larger organization like UW Medicine, MultiCare, Eastside Health Network, or the Everett Clinic. These plans don't cover out-of-network providers so you will have to self-pay at the time of service.
Starting 1/1/2021, we will not be in-network with the Blue High Performance Network.
Self-funded plans and "trusts" make their own rules. VERY important to check benefits in advance for these plans.

REGENCE MEDICARE ADVANTAGE PLANS

PPO plans -- We are in-network. A doctor's referral with a diagnosis of diabetes or chronic kidney disease is required.
HMO Plans -- We are not in-network with their Med Adv HMO plans. These plans don't cover out-of-network providers so you will have to self-pay at the time of service.

COMPANIES WE DO NOT ACCEPT:

AMERIGROUP

We do not accept Amerigroup. However, reduced rates are available to clients with Apple Health (Medicaid) plans. Please contact us to discuss rates and eligibility.

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 rates and eligibility.
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.

COMMUNITY HEALTH PLAN OF WASHINGTON

We do not accept CHPW. However, reduced rates are available to clients with Apple Health (Medicaid) plans. Please contact us to discuss rates and eligibility.

MOLINA HEALTHCARE

We do not accept Molina Healthcare.
For Apple Health (Medicaid) plans: Reduced rates are available to clients with Apple Health (Medicaid) plans. Please contact us to discuss rates and eligibility.
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.

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 rates and eligibility.
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.
If you would like to seek reimbursement, we highly recommend having your doctor send us a referral with your full diagnosis list since UHC generally does NOT cover the diagnosis code Z71.3 that we use in the absence of a referral. UHC provides best coverage for clients with a BMI of 25+ who also have a cardiovascular risk factor, such as high blood pressure, high cholesterol, family hx of CVD, etc. If that applies to you, be sure your doctor includes those codes in the referral!

WASHINGTON APPLE HEALTH (MEDICAID)

We do not accept Washington Apple Health (Medicaid). However, reduced rates are available to clients with Apple Health (Medicaid) plans. Please contact us to discuss rates and eligibility.

FOR THE TIME BEING, WE ARE PROVIDING ALL SERVICES VIA VIDEO CALLS (AKA TELEHEALTH).