Insurance Reimbursement

Every insurance plan is different. Some clients receive 60 to 80% reimbursement after their deductible is met. Others receive less or nothing depending on their plan type and benefits structure. The only way to know what applies to you is to make the call.

Many clients are pleasantly surprised. The out-of-pocket cost after reimbursement is often less than expected — and in many cases less than an in-network specialist copay once all costs are factored in.

The following steps are a guide to help you better understand what your insurance will cover.

How to Use Your Insurance Benefits for Dietitian Services

Call the Member Services Number on Your Insurance Card

1

Before your first appointment, call the member services number on the back of your insurance card. This call is important and worth taking 15-20 minutes to do properly. Ask to speak with a benefits specialist and let them know you are inquiring about out-of-network coverage for telehealth dietitian services.

Ask These Questions

2

Write down the answers — including the name of the representative you spoke with and the date of the call. This protects you if there is ever a discrepancy later.

Ask about your coverage:

Do I have out-of-network benefits for outpatient dietitian or medical nutrition therapy services?

Is telehealth covered for out-of-network dietitian services?

What is my out-of-network deductible and has any of it been met?

What percentage does my plan cover for out-of-network services before or after my deductible is met?

Is there a limit on the number of visits covered per year?

Do I need a physician referral or prior authorization for dietitian services?

Ask about specific CPT codes:

Let the representative know you want to verify coverage for the following specific procedure codes used by registered dietitians:

97802: Medical nutrition therapy; initial session (will be used 1x for initial session)

97803: Medical nutrition therapy; reassessment and intervention (will be used for all follow up sessions)

Ask about specific ICD-10 diagnosis codes:

Let the representative know you want to verify coverage under the following diagnosis codes that may apply to your care:

ICD-10 Code

Z71.3 Dietary counseling and surveillance

E28.2 Polycystic ovarian syndrome

E66.3 Overweight

E66.9 Obesity

E11.9 Diabetes, Type 2

R73.09 Prediabetes / other abnormal glucose

Understand What You Are Listening For

3

Here is what the answers mean for you practically:

If you have out-of-network benefits: Most PPO plans include out-of-network benefits. This means your insurance will reimburse you a percentage of the cost after your deductible is met. For example if your plan covers 70% of out-of-network services and your deductible is already met, you may receive back 70% of the allowed amount for each session.

If you have an HMO: HMO plans typically do not cover out-of-network services except in emergencies. If you have an HMO you will likely be responsible for the full cost of services. However it is still worth asking as some HMOs have exceptions for specialists not available in-network.

If prior authorization is required: Some plans require you to get approval before services begin. If this applies to you I can provide a letter of medical necessity for you to submit to your insurance. Contact me before your first appointment so we can get this in place.

Confirm Your HSA or FSA Eligibility

4

Even if your insurance coverage is limited, dietitian services typically qualify as a Health Savings Account (HSA) or Flexible Spending Account (FSA) eligible expense. This means you can pay for your sessions with pre-tax dollars, which reduces your effective out-of-pocket cost significantly. Ask your HR department or benefits administrator to confirm your specific plan's eligibility.

Questions?

If you have questions about any part of confirming insurance coverage, please reach out. I want this process to be as easy as possible for you.

Note: Insurance benefits are determined by your individual plan. The information above is intended as general guidance to help you navigate the process. I am not able to guarantee coverage or reimbursement for services.