Insurance

Cool fact: You can often use your health insurance for your nutrition visit

If you have nutrition coverage on your insurance plan you will often be covered for the cost of your visit.

Let’s work toward improved health & overall wellness!

Most health insurance companies do cover nutritional counseling with a registered dietitian.

So in most instances you CAN use insurance for your nutrition visit.

But YOU need to call to verify and confirm you do in fact have benefits on your insurance policy for nutritional counseling.

This is often the case EVEN if you don’t have an actual diagnosis BUT still want to come in for nutrition counseling for prevention of a disease.

Why not check to see if your insurance policy will cover the visits? Start by calling the 800 number on the back of your insurance card and ask to speak with a representative.

Remember that YOU (not GNW) need to do this BEFORE scheduling your visit.

What insurance companies does GNW participate with?

At the present time, GNW is a preferred provider with Aetna, Medicare, Cigna, United HealthCare, Blue Cross and Blue Shield & Amerihealth. Medicare only covers the visit if you have diabetes or renal disease. Medicare DOES NOT cover for nutritional counseling for pre-diabetes or obesity in an outpatient setting at this time.

I live far away, can I use my insurance for telehealth services?

Most insurances are still covering for telehealth services. Therefore, when you schedule your visit you will be directed towards the next steps to setting up properly for your telehealth session. However, it is possible your insurance plan may impose a cost-share for you to use this service. Please call your insurance company to confirm your telehealth coverage PRIOR to scheduling your visit.

With that being said, if you prefer to be in-person, the office is 309 Orange Road Montclair, NJ.

What happens if you do not participate with my insurance?

Currently, GNW participates with most major insurance companies. So if you have benefits you can use insurance for your nutrition visit.

However, all insurances plans do NOT cover nutrition. Therefore, you are required to call your insurance company prior to scheduling your visit to confirm your nutrition visits will be covered. Please follow the steps below ‘What questions should I ask when calling my insurance?’

In the event, your claim is denied for lack of nutrition coverage our initial visits (60-minutes) are $160.00 and each follow-up visit (30-minutes) is $70.00. GNW accepts cash, check, HSA/FSA cards and all major credit cards.

What questions should I ask when calling my insurance company?

Please note it is the patient’s responsibility to call their insurance company PRIOR to your visit to confirm coverage. No one wants to receive a surprise bill.

Do I have nutritional counseling coverage on my insurance plan?

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. We also can bill for S9470 if it is covered on your policy.

Will my diagnosis be covered?

If the representative asks for a diagnosis code (aka ICD 10 code) – please tell them the visit is coded the ICD 10 code: Z71.3
If they don’t accept Z71.3 then provide them with Z72.4 and see if they will cover that diagnosis instead on your plan.
If you are overweight, obese, have pre-diabetes, diabetes, hypertension, or high cholesterol you may want to see what your coverage is for these diagnoses as well.
We always code your visit 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: IBS, and you are not overweight or have CVD risk factors) 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?

A 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.
GNW 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 do 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 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 dietitians 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, often because 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.

Summary of questions to ask to verify your nutrition benefits

Do I have coverage for nutrition counseling?
Do I need a referral to see a Registered Dietitian?
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 there an associated cost for me if I choose to have the appointment as a telehealth visit versus in person visit?

If you have any questions after verifying your benefits please email tracygottschalk@me.com