YES! You can use your insurance for nutrition and diabetes consults
You might be wondering how insurance works if you want to see a Registered Dietitian for diabetes and nutrition visits.
Is using insurance really an option?
Will insurance cover the cost of your diabetes and nutrition visit?
Absolutely!
Most health insurance companies do cover nutritional counseling for diabetes.
So, in most cases, you CAN use insurance for your diabetes and nutrition visit.
However, YOU (not us!) need to call and verify that your insurance policy includes benefits for nutritional counseling (details below!).
This is often true even if you don’t have a specific diagnosis but want to seek nutrition counseling for disease prevention.
Why not check if your insurance policy covers these visits? Start by calling the 1-800 number on the back of your insurance card and ask to speak with a representative.
The information below will guide you through the steps to determine if your insurance will cover the cost of diabetes and nutrition counseling for your visit.
Once again (not to sound like a broken record), YOU (not us!) need to do this BEFORE scheduling your visit. We don’t like surprises, and we assume you don’t either (especially the owe-us-money surprises).
But yes, in most situations, you can use insurance for your nutrition and diabetes visits.
Commonly Asked Questions About Insurance
What insurance companies does Above Diabetes LLC participate with?
UTAH: we currently accept Regence, Aetna, UHC, PEHP, and Select Health (Choice and Care network)
TEXAS: we currently accept, BCBS, BSW (tier 2), Aetna, and UHC
We do not work with Medicaid or Medicare, but do offer discounted cash-pay options.
I live far away, can I use my insurance for telehealth services with Above Diabetes LLC?
Most insurances cover telehealth services. When you schedule your visit, you will be guided through the steps to set up your telehealth session. However, your insurance plan may require a cost-share for this service.
We also have a small physical location in Anna, Texas, for those needing in-person visits: 8970 County Road 512, Anna, TX, 75409.
Please call your insurance company to confirm your telehealth coverage BEFORE scheduling your visit.
What happens if you do not participate with my insurance?
If you have benefits, you can use insurance for your nutrition or diabetes visit.
However, not all insurances cover nutrition. Therefore, you must call your insurance company prior to scheduling your visit to confirm coverage. Follow the steps below in “What questions should I ask when calling my insurance?”
If your claim is denied due to lack of nutrition coverage, our initial visits are $155.00, and each follow-up is $130.00. All consults are 60 minutes.
Above Diabetes LLC accepts cash, check, HSA/FSA cards, and all major credit cards.
Do I have nutritional or diabetes counseling coverage on my insurance plan?
If the insurance company asks for a CPT code, provide them with 97802 and 97803. If these are not covered, ask them to check 99401, 99402, 99403, and 99404. We can also 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 (nutrition) or E10.9 (type 1 diabetes) or E11.9 (type 2 diabetes).
If you need nutrition education (diet and lifestyle), we will code preventative, with or without diabetes.
If you need help with diabetes relating to MDI or pump adjustments, medication adjustments, or strictly pump education, we will code diabetes.
We will also code preventative (if applicable) to maximize visits covered and to reduce your costs. Often times preventative is absolutley no cost to you (not even a copay)!
For diabetes-only visits, you’ll need a referral from your doctor. Your insurance may impose a cost-share through your deductible, co-pay, or co-insurance.
To get a referral, simply call your doctor and have him/her fax the referral to Above Diabetes LLC (Fax Number: 801-702-8143)
How many visits do I have per calendar year?
Your insurance will inform you how many visits they cover, which can range from none to unlimited, depending on medical need.
If you have diabetes, I would ask number of visits for nutrition (Z71.3) AND for diabetes (E10.9 for type 1) or ( E11.9 for type 2)
Do I have a cost-share for my nutrition visit?
A cost-share is the amount you pay according to your insurance plan, which can be a deductible, co-pay, or co-insurance.
We will bill under your plan’s preventative benefits for nutrition if allowed, which often means NO cost-share. Confirm this with your insurance prior to your visit.
For diabetes-specific visits, there may be a cost to your deductible, cost-share, or coinsurance. Both types of visits will go through your insurance.
If you have a cost-share, we will bill your insurance company first. Once we receive the EOB indicating your responsibility, we will charge the amount to the credit card on file.
Dietitians are usually considered specialists by most insurance companies, making your specialist co-pay applicable at the time of service. This information is often on the front of your insurance card. However, when we bill for preventative counseling, the co-pay is often not applicable (meaning no cost to you).
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.
What number do I call to check insurance coverage for nutrition and diabetes consults?
Call the 1-800 number on the back of your insurance card and ask to speak with a representative.
Summary of questions to ask to verify your nutrition benefits?
1. Do I have coverage for nutrition counseling?
2. Do I need a referral to see a Registered Dietitian for nutrition? Referrals from your doctor are ALWAYS required for diabetes.
To get a referral, simply call your doctor and have him/her fax the referral to Above Diabetes LLC (Fax Number: 801-702-8143)
3. Are my diagnoses covered on my particular plan? (Z71.3 for nutrition, E10.9 for Type 1, E11.9 for type 2)
4. How many visits per calendar year do I receive?
5. Do I have a cost-share for these services?
6. Is there a cost difference between telehealth and in-person visits?
If you have any questions after verifying your benefits we are happy to help. Please email support@abovediabetes.com. We will return your message within 48 business hours.