How to Verify Insurance Coverage for Nutrition Services

How to Verify Insurance Coverage – Please Read Carefully

Belly Bliss Nutrition is currently in-network with Aetna and Blue Cross Blue Shield.

  • Sara Kahn, MS, CNS, CDN accepts Aetna.
  • Ellen Biemiller, MS, CNS, LDN accepts Blue Cross Blue Shield PPO plans.

 

You may be able to use your insurance benefits towards the Belly Bliss Gut Healing Program.

 

If you don’t have Aetna or Blue Cross Blue Shield, your insurance may offer out-of-network coverage for nutrition counseling.  If this is the case, we can provide you with a superbill (receipt) so you can get reimbursed.

 

Please read this page in its entirety to fully understand what’s involved with using your insurance benefits for nutrition counseling.

 

  • So there are no financial surprises, we require all patients (that’s YOU not us) to verify their insurance coverage before booking the initial consultation.
  • Insurance will only cover our 1:1 strategy sessions and does not cover the other supportive features of our program including messaging, food/symptom journal review on our app, Belly Bliss Blueprint, meal planning resources, and more.
  • The great news is that your insurance benefits can significantly reduce the cost of the Belly Bliss Gut Healing Program!  Please review this page to see the full costs, benefits and payment plan when using insurance.
  • If you are not interested in the Belly Bliss Gut Healing Program with the unparalleled amount of support and only want to do nutrition counseling sessions, please verify your insurance coverage and schedule a call to learn more.

 

How Using Insurance Works with the Belly Bliss Gut Healing Program

  • If your insurance covers nutrition counseling, you will have a lower monthly payment plan and we will bill insurance to cover the 1:1 strategy sessions after each session.
  • Depending on your plan, the 1:1 strategy sessions may be covered at 100% or you may incur a cost-share. In the event of a cost-share, we will bill the credit card on file once we receive the EOB (explanation of benefits) from the insurance company.

How to Verify Insurance Benefits

Again, in order to avoid any financial surprises, we require all patients using insurance to verify their own insurance coverage and determine if there are any additional out-of-pocket costs associated with your plan.

 

Here are the exact steps to take and the exact questions to ask to ensure you have insurance coverage and to understand your exact financial responsibilities.

 

1. Call the toll-free number on the back of your insurance card and ask to speak to a representative.

 

2. Questions to ask:

 

Do I have nutritional counseling coverage on my insurance plan?

  • Yes
  • No (if no, then no need to proceed any further). You will be responsible for all costs associated with our nutrition services.

 

If you DO have nutritional counseling coverage, and the insurance company asks for a CPT code please provide them with the following codes:

  • 97802
  • 97803

 

Do I have healthy eating coverage for nutrition counseling using ICD-10 code Z71.3?

  • Yes
  • If not, then ask the following question.

 

If you are overweight, obese, have pre-diabetes, diabetes, high blood pressure, or high cholesterol, ask if you have preventative coverage for nutrition counseling using ICD-10 code Z71.3?

  • Yes
  • If not, then ask the following question.

 

Will my diagnosis be covered?

  • If you are overweight, obese, have pre-diabetes, diabetes, high blood pressure, or high cholesterol you may want to see what your coverage is for these diagnoses.
  • We always code your visits using preventative coding (if applicable) to maximize the number of visits you receive from your insurance carrier. However, if you ONLY have a medical diagnosis (for example: you have IBS, and you are not overweight, obese, have pre-diabetes, diabetes, high blood pressure or high cholesterol, your insurance may impose a cost-share for your visit either in the form of a deductible, co-pay or co-insurance).

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 vary from 0 to unlimited depending on medical need.

 

Do I have a cost-share for my nutrition visit?

  • cost-share is the amount you will need to pay as required by your particular insurance plan towards your services. A cost-share can be in the form of a deductible, co-pay or co-insurance.
  • We will always bill under your insurance policy’s plan under your preventative benefits if your plan allows. With that being said, if you have preventative benefits there if often NO cost share for you associated with the visit. Once again, this is something YOU want to ask prior to your visit.
  • In the event you have a cost-share, we will initially bill your insurance company directly.  Once we receive the EOB (explanation of benefits) describing your responsibility as the patient, we will bill the credit card on file for the amount noted under ‘patient responsibility’.
  • For most insurance companies nutritionists are considered a specialist. 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. However, if we bill your insurance with preventative counseling the co-pay is often not applicable.
  • We generally wait for the claim to be processed to determine whether or not you have a co-pay and then charge the credit card you have on file with us the co-pay amount. 

 

If you are using Aetna, Sara Kahn is based in NY. If you live outside of NY, does your plan allow you to see providers outside of your state via telehealth?

If you are using Blue Cross Blue Shield, Ellen Biemiller is based in IL.  If you live outside of IL, does your plan allow you to see providers outside of your state via telehealth?

  • Yes
  • If not, then ask if it covers out of network providers. If so, you will be required to pay for the entire program cost and we will provide a Superbill for the 1:1 strategy sessions so you can get reimbursed by your insurance carrier.

 

Is there a cost associated with telehealth visits?

  • If yes, what is cost?
  • No, telehealth is covered

 

Do I need a referral to see a nutritionist?

  • If yes, please ask your doctor for a referral and have them fax it to 332.206.0009. This will need to be received before the scheduled initial consult.
  • No

 

What is the call reference number? 

  • We always recommend getting the call reference number in the event there is an issue with billing or reimbursement.

 

Summary of questions to ask to verify your nutrition benefits:

  • Do I have coverage for nutrition counseling?
  • Does my plan offer preventative coverage or are my diagnoses covered on my particular plan?
  • How many visits per calendar year do I receive?
  • Do I have a cost-share for these services?
  • Is telehealth covered?
  • If you live outside of NY or IL, are you allowed to see providers based out of state via telehealth?
  • Do I need a referral to see a nutritionist?
  • What is the call reference number?

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