Understanding Insurance And Aligned Nutrition
We understand working with insurance can be confusing and frustrating at times. We want to do our best to help you navigate the process and figure out whether our sessions together are covered by your insurance plan.
Coverage for nutrition services is highly variable and ever changing. Coverage often depends on what benefits you and your employer select, deductible amounts, specific diagnoses, and maximum yearly allowances set by your contract.
In other words, coverage does not depend on if a provider "takes" your insurance or whether we are In- or Out-of-Network providers.
An Out-of-Network Provider has not been credentialed or signed a contract with the particular insurance company. You may have a lower deductible or co-payment for selecting an In-Network provider.
We choose to be Out-of network providers so that we can devote our time to you and your care instead of administrative time spent appealing insurance payments. Because we believe in what we do, we always hope your plan covers our services! Choosing to be an Out-of-Network provider was a difficult decision we made as a result of previous experience working directly with insurance companies.
Payment for services is collected at the time of our visit. You will be provided with a superbill for reimbursement. A superbill is a detailed receipt with billing and diagnosis codes. If you are used to paying a co-pay and having your doctor submit directly to your insurance plan, then this is the exact opposite of your usual process.
A superbill does not guarantee reimbursement but there are some things you can do to understand if your plan covers our visits. Please remember it is your responsibility to understand what your plan does and does not cover.
Here are some necessary steps in understanding your coverage
Call the member services number on the back of your insurance card and ask (You may need Erica's NPI: 1407170780):
Does my plan cover nutrition counseling? Yes or No
If yes, how many sessions are allowed? __________________
Are the CPT codes 97802 & 97803 valid & billable? Yes or No
Is coverage limited to certain medical diagnoses? _____________
Does my plan only cover visits that are considered “medically necessary?” _____________________________
Do I have a deductible to meet first? Yes or No
If yes, how much? ________________
How much has been met? _______________
Do the stated benefits differ between for In- or Out-of Network providers?
*Note: Representatives will often automatically quote In-Network benefits, so it is important to ask this
Do I need a physician referral? Yes or No
Record time called, representative name, and ask for a reference number for your call: _____________________