Most health insurance plans cover nutrition visits with us, usually at NO COST to you!
We have listed some information below based on our knowledge and experience with billing. However, since you are ultimately responsible for payment, we highly recommend you call the number on the back of your insurance card and ask them some specific questions. Click here to view the questions.
We must receive a referral and medical diagnosis codes from your physician in order to submit claims. Please have your doctor fax it to us at 206-866-0204 along with your full diagnosis list, clinical notes, and labs. **If we do not receive this, you will need to self-pay at the time of service.
Diagnoses covered:
Preventive "Healthy Diet Counseling" is covered at no cost for people with "obesity" alone, or "overweight" PLUS a cardiovascular risk factor (i.e. hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome).
Most other diagnoses are covered as medical so may apply to deductible/copay.
ADHD, asthma, and chronic fatigue are NOT covered.
For regular Aetna plans (not Meritain, GEHA, etc.), all appointments are limited to 55 minutes. This is often not enough time for an initial visit so we offer the option for clients to self-pay for the additional time.
We are in-network with Aetna's Medicare Advantage Plans. Aetna Medicare plans only cover DM and CKD and have all the same rules as straight Medicare. See our "Medicare" section below for more information.
BLUE CROSS BLUE SHIELD
We are considered in-network for out-of-state BCBS PPO plans, such as Anthem, BCBS of Illinois, BCBS Federal, CareFirst, and dozens more.
BCBS plans generally cover nutrition visits in full as preventive, no referral required, however there are countless different plans throughout the country and they each have their nuances.
While we ALWAYS recommend calling your Insurance to check benefits for nutrition counseling, it is especially important with these plans since we are less able to catch issues before providing services.
If your plan only covers certain diagnoses, ensure your doctor sends us documentation of them so that we may use them to bill.
CIGNA - Diagnosis code(s) required
We must receive medical diagnosis codes from your physician (or mental health provider for ED codes) in order to submit claims.
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.
KAISER PERMANENTE - Referral + authorization required for HMO planS
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.
Options PPO Plans:
Referral/ prior authorization are NOT required.
Nutrition visits are usually covered at 100%, meaning no cost to you.
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: 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.
MEDICARE - Referral required
MEDICARE PART B
Nutrition therapy is ONLY covered with a diagnosis of diabetes or pre-dialysis kidney disease (CKD). 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, and a new one must be obtained for each calendar year. 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, Regence etc. We bill the insurance company, not Medicare.
Medicare Advantage Plans generally have the same coverage requirements and limits as Medicare part B, but there is possibility for additional coverage. Kaiser is the only MedAdv company we have seen cover additional diagnoses beyond just diabetes and kidney disease.
Referrals are still required.
We are not in-network with Premera's Med Adv Plan.
We are in-network with Regence's PPO and HMO Med Adv Plans.
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. "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 and HMO)
A physician's referral with a diagnosis of diabetes or chronic kidney disease is required. Clients without a referral or covered diagnosis must self-pay at the time of service and sign a standard ABN (Advanced Beneficiary Notice of NonCoverage) form.
RATES: Initial Nutrition Appointment, up to 85 minutes: $300
20% discount when paid at time of service and no insurance involvement = $240
50% discount with proof of active Medicaid enrollment = $150
Follow-Up Nutrition Counseling, up to 55 minutes: $180
20% discount when paid at time of service and no insurance involvement = $144
50% discount with proof of active Medicaid enrollment = $90
Cut to the Chase Food Sensitivity Program (MRT+LEAP): Book a mini consult call to discuss MRT+LEAP is only available to clients enrolled in our 12 week all inclusive food sensitivity program. A portion of the program can be billed to insurance and a portion cannot. Your cost will vary depending on your insurance coverage.
Late Cancellation & No Show Fees: $100 We require a full 48 hours notice to cancel or reschedule appointments. If you tell us within that 48 hours of the appointment that you cannot attend, we will waive the fee if we are able to reschedule you for the same Mon-Sat week and you complete that appointment.
PAYMENT: A valid credit/debit card on file is required and will be charged for self-pay fees, amounts insurance tells us are your responsibility after claims processing, and in case of late cancel or no show. You may also keep a HSA/FSA card on file for eligible transactions. Any refunds issued will be less the card processing fees we have incurred. If your insurance does not cover your visit(s) for any reason, you are responsible for the full amount billed.
