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 - Please read coverage details below
Blue Cross Blue Shield
Cigna
First Choice Health / Moda Health / Health Net of Oregon
Kaiser Permanente (referral/ authorization required for HMO plans)
Medicare - Please read coverage details below
Premera Blue Cross / Lifewise (NOT Medicare Advantage Plans)
Regence Blue Shield / Uniform Medical / Bridgespan / 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 any restricted diagnoses? (ask specifically about the diagnosis code Z71.3 and if its covered as preventive)
Do I need a referral or prior authorization?
Is nutrition counseling covered when provided via telehealth?
How many visits are covered?
Do I have a deductible to meet before insurance pays?
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

Aetna has very specific coverage requirements. Please read this thoroughly and contact us if you have any questions.

A medical diagnosis is required for coverage.
- Since dietitians are not able to diagnose medical conditions, you'll need to provide us with documentation of a specific ICD-10 code(s) from your doctor that we can use for billing. The only time we do not need this is if your BMI is 30 or higher or, for pediatric clients, your child's BMI is at or above the 85th %ile.
- Aetna covers most diagnoses other than ADHD, asthma, chronic fatigue, or the ICD-10 code Z71.3.
- You can...
  - Have your doctors office fax us just your ICD-10 diagnosis list or a referral that includes the code(s). Our fax number is (206) 866-0204.
  - You may be able to login to your doctor's patient portal and access the codes yourself. If so, take a screenshot and upload it into our patient portal or print it out and bring it with you to your appointment. Be sure whatever you give us clearly shows both your name and the code(s).
  - Diagnosis codes are often printed on the Explanation of Benefits (EOB) statements provided to you by your insurance company following your appointments. If so, you can upload an EOB from a doctor's visit into our patient portal.
- If we don't have codes to bill with, you will need to self-pay at the time of service.
Telehealth is categorically covered during COVID at least through August 4th. (Normally, telehealth is not always covered.)
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 standard intake session (up to 85 minutes).
Detailed information on coverage can be found in Aetna's Policy for Nutritional Counseling.
Self-funded plans and "trusts" make their own rules. VERY important to check benefits in advance for these plans.

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. Out-of-state plans are not subject to Washington state laws.
While we ALWAYS recommend calling your Insurance to check benefits for nutrition counseling, it is especially important with these plans. That said, most plans DO cover visits with us.
A doctor's referral is typically not required.
Telehealth is usually covered but some plans may choose to not cover it. You can call your insurance company to find out.
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 usually with a copay/coinsurance.
Telehealth is usually 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 / MODA HEALTH / HEALTH NET PLAN OF OREGON

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.
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.

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 the "Medicare" section for additional details on KP's Medicare Advantage Plans.

PPO or "Options" 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.
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.
Providers you see need be in-network with the insurance company and usually Medicare too in order to be covered.
Medicare Advantage Plans may cover additional diagnoses that straight Medicare doesn't and may also cover more visits.
A referral is still required by most plans.

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

Don't provide any additional benefits beyond straight Medicare. If straight medicare won't cover it, a Medicare Supplement won't either.

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 / BRIDGESPAN / ASURIS / HMA

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.

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.

WE ARE OPEN DURING COVID-19!
For everyone's safety, we are providing services via video calls (aka telehealth) for new and existing clients.