We are in-network providers for Aetna, UHC (including Medica and Preferred One) and Medicare and out-of-network with BCBS. PPO plans with out-of-network benefits can qualify for reimbursement.
New Service: If you want us to check your benefits for you - we can do so for a $20 fee. If you would like for us to do that, simply email us a front + back picture of your medical card, name and DOB of person wanting services and a best phone number to reach you. Once you pay our invoice from Stripe we will verify your benefits. If you want to check your own, please use the checklist at the bottom.
BCBS - we were approved to be out-of-network with them. Our services will be applied to your deductible and/or may require a copay. If you do, we will file claims for you like a standard in-network process.
The Gist: Private insurance nutrition counseling for Overweight and Obesity, Healthy Weight and Weight Gain During Pregnancy is FREE! Aetna will additionally cover healthy eating with a normal BMI for FREE! PPO plans that include out-of-network MNT benefits can reimburse you for the care you get from us. We also accept HSA/FSAs + cash pay.
Attention PPO Plans: If we are not in-network with your insurance, PPO plans can still include out-of-network MNT benefits and help pay for care you get from us. Call your insurance rep and ask if you have MNT coverage and the steps needed for you to submit the superbill. The standard process is that you would work with us and we provide you with a Superbill (aka invoice) to submit to your plan for reimbursement. The percent of reimbursement is unique to your plan. Contact your insurance plan for more details.
Insurance Coverage Medical Nutrition Therapy (MNT) : Preventative vs Medical
It’s common for insurance companies to provide two types of MNT services: Preventative and Medical
Preventative MNT: These services can often be utilized at NO COST to you. These include consulting for weight loss (if overweight or obese), Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults with Cardiovascular Risk Factors and Healthy Weight and Weight Gain During Pregnancy. Aetna offers healthy eating without weight loss usually 10 visits per year
Medical MNT: These benefits are utilized for diseases like Type 2 diabetes, chronic kidney/renal disease, gestational diabetes, celiac disease, gastrointestinal disorders, hypertension, seizures (i.e., ketogenic diet), eating disorders, etc. when it is prescribed by a physician. When we bill for MNT under a your medical benefits, a copay or deductible may be applicable. However, if you have diabetes AND need to lose weight, we can bill Preventative MNT for weight loss.
How to Use Insurance:
All clients using their insurance will participate in the 3 Month Clinical Nutrition Membership whether or not your insurance covers all or part of it, the great news is that traditionally Aetna and UHC plans offer enough coverage for the whole membership plus more. Medicare clients automatically have half of the Membership covered, but can obtain full Membership coverage who agree to a second referral to obtain additional covered appointments (see below). HSA + FSA funds can be used for our services as well at the reduced cash-pay rate.
Covered Private Medical Insurance Carriers:
Each plan is unique. You will need to understand yours by completing our checklist provided once you schedule your 90-Minute Clinical Nutrition Initial Consult an example checklist is also linked at bottom to review ahead of time:
Aetna - Usually many visits covered, but tend to have a 1 hour limit (including Initial)
UHC/Preferred One - Preventative often free and unlimited for overweight/obese diagnoses. Diabetes might have copay, potentially unlimited visits. Other conditions call for coverage.
Blue Cross Blue Shield - Services counts towards deductible or co-pay.
Ucare/Medica - hopefully coming soon
If you don’t have the insurances mentioned, we can offer you self-pay options and provide a Superbill so you can try to get reimbursement for what you have paid.
Medicare - Type 2 Diabetes or renal disease diagnosis:
Doctor’s referral required
3 nutrition consultation hours covered the first year. You can see your doctor to assess for a change in renal function or A1C levels (either up or down) and get a second referral that can allow another 3 -12 hours. Otherwise without referral, 2 hours are covered the following year.
How to get started:
Review the checklist at bottom, get familiar with it because it will need to complete it prior to your 90-Minute Initial Consult (Aetna Clients will have 60-Minute Initial Consult due to policy appointment time limits).
If you are requesting a Free 30-Minute Consult first with the goal to use insurance, please call your medical insurance customer service to fill out the Checklist before we meet to confirm your coverage. Otherwise…
Schedule your 90-Minute Initial Consult 1-2 weeks out; give yourself enough time to call your medical insurance customer service information plus the other 4 required electronic questionnaires. *The official insurance coverage checklist will be sent to you as a questionnaire to complete in CharmPHR along with the other questionnaires. All need to be completed 2 days prior to your appointment otherwise you will incur a cancellation/rescheduling fee to your credit card on file.
If you/we find out you do not have insurance coverage for our visit after you started, you will be charged the cash pay rate to your card on file.
All insurance coverage appointments are televideo
We will need a front copy of your medical card. Gender. If the patient is not the primary insured we’ll need the name and DOB of the person who is (parent, spouse, etc)