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Insurance
Will Insurance Cover My Visit?
Due to the many types of insurance plans and policies, the provider can’t know your specific policy or plan requirements. Patients are responsible for knowing and understanding all applicable insurance policies. To obtain accurate billing information, we require a copy of your insurance card and identification card prior to your appointment. Note that we cannot file or accept the assignment of your insurance unless you provide proof of all insurance information. Failure to provide sufficient insurance information 48 hours prior to your appointment time will result in you being charged the self-pay rate.
PLEASE NOTE: we do not verify benefits on behalf of our patients. Use the helpful information below or call the number on the back of your insurance card for plan details and coverage for nutritional counseling.
Will Insurance Cover My Visit?
We are considered IN-NETWORK providers with Anthem BCBS, Aetna, Cigna (not part of HMO Connect), Humana, Ambetter, United Healthcare (plan specific), and Caresource- Marketplace and Caresource-Medicaid (18 years or younger). We are also Medicare Part B providers.
Will Insurance Cover My Visit?
We are considered IN-NETWORK providers with Anthem BCBS, Aetna, Cigna (not part of HMO Connect), Humana, Ambetter, United Healthcare (plan specific), and Caresource- Marketplace and Caresource-Medicaid (18 years or younger). We are also Medicare Part B providers.
Amerigroup +Caresource-Medicaid Patients:
Some Anthem HMO plans require a referral to see a specialist (these are most often the Anthem Pathway X Guided Access plans). Please check the front of your card for a PCP’s name and phone number. Often, the back of your card has the wording: “referral required to see specialist”. If your current PCP is not the one listed on the front of your card, please call the number on the back of your card to link your current PCP to your account.
BCBS OF NEBRASKA: These plans do not allow registered dietitians to bill directly for medical nutrition therapy. While we may pull up in network, the claims will be denied as they require the billing to be under a facilty/doctor’s office. You will need to be self-pay with us if your home plan is BCBS of NEBRASKA.
Anthem Patients:
Due to the current state regulations in Georgia, we as Registered Dietitians can only bill directly to Medicaid Care Management Organizations (like Amerigroup and Caresource) for patients who are 18 years old or younger.(https://georgiaaccess.gov/get-covered/other-health-coverage-programs/peachcare-for-kids/)
If the patient is 19 years or older, you would need to be self-pay if being seen by us. Our self pay rate are $185 for the initial consultation and $85 for follow ups.
Frequently Asked Questions for Insurance Company
What if the insurance company asks for a CPT code?
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.
What if I need continuous glucose monitoring?
We are now offering continous glucose monitoring at our office locations. Please verify with your insurance provider if the CPT code 95249 is a covered service.
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 medical nutrition therapy/ nutritional counseling. We always try to code your visit using preventative coding to maximize the number of visits you receive from your insurance carrier. Aetna also typcially has obesity prevention coverage on most plans.
