WILL INSURANCE COVER MY VISIT?
We are considered IN-NETWORK providers with Anthem Blue Cross, Blue Shield, UHC, and Aetna*. We are also Medicare providers. Please keep in mind that MEDICARE will only cover nutrition counseling with a diagnosis of diabetes or renal disease. Other conditions will NOT be covered if Medicare is your only carrier. This includes Aetna Medicare Advantage Plans. *Please note that we now require referrals for all Aetna patients.
We are considered OUT OF NETWORK with any other provider. If you would like to use an out of network insurance provider, you would pay our self-pay rates at the time of service and we can provide a Superbill that you can submit to your provider for reimbursement. Just let us know!
Questions for Your Insurance Company: If the insurance company asks for a CPT code please provide them with the following codes 97802 & 97803. If they say you do not have coverage using those codes NEXT ask them to check your coverage for the following CPT codes: 99401, 99402, 99403 and 99404.
Will my diagnosis be covered? If the representative asks for a diagnosis code – please tell them the visit is coded the ICD 10 code: Z71.3 (for Anthem/BCBS/UHC) OR Z72.4 (for Aetna). We always try to code your visit using preventative coding to maximize the number of visits you receive from your insurance carrier.
How many visits do I have per calendar year? Your carrier will let you know how many visits they are willing to cover. Depending on the carrier the number of visits varies from 0 to unlimited depending on medical needs.
Have I met my deductible? In the event that you have a deductible AND you are an out of network carrier, I will not be able to initially bill your insurance company directly. Therefore, payment of $160.00 is due at the initial visit and $80.00 is due at each follow-up visit.
We will provide you with the appropriate documentation to submit to your insurance company to show receipt of the services. This will allow you to “pay down” your deductible. Once your deductible has been met and you have nutrition services on your policy, I can then directly bill your insurance company.
Do I have a co-pay for nutritional counseling? For most insurance companies we are considered specialists. Therefore, your specialist co-pay is applicable and is payable at the time of service. This information is often apparent on the front of your actual insurance card.
Do I need a referral? Be sure to ask your insurance company if a referral is required in order to see a dietitian. If required, you can request a referral from your doctor and have it faxed to us at 559-500-5090. We must have the referral BEFORE the appointment in order for your visit to be covered.
Be sure to ALWAYS get a reference code from any representative you speak with at your insurance company. This helps to keep the insurance company accountable for any information they provide you with on your call.
In light of COVID-19, many insurance companies are waiving all member cost-shares. So please be sure to specify that this will be a TELEHEALTH appointment so that you have the correct information (in case your appointments are via telehealth).
Once you find out your coverage contact our office to schedule your appointment. We look forward to serving you.