Access to health insurance has improved, but for many, costs have not. While you may have health insurance, high deductibles and co-payments make accessing benefits unrealistic for far too many individuals. Unfortunately, many don’t investigate what their health insurance covers, even if it’s a high deductible plan.
Regardless of deductibles and co-payments, you may still have access to some preventive health benefits with little to no out-of-pocket cost to you. Often, preventative health appointments don't cost the health insurance companies much up front but save huge amounts in the long run. Many people are unaware their high deductible health insurance plan may cover seeing a Registered Dietitian Nutritionist with little to no out-of-pocket costs.
Here are some important things to know about your health insurance and your coverage, and options when it comes to seeing a Registered Dietitian Nutritionist (RDN).
First, Health Insurance will not cover seeing a “Nutritionist” or “Health Coach”. For you to see a nutrition professional using health insurance they must earn and maintain their RDN credentials through the Commission on Dietetic Registration, obtain a National Provider Identification (NPI) number, and in certain states be licensed through the state they are offering services in. A “Nutritionist” or “Health Coach” cannot be licensed or bill health insurance in any state because there is no consistent requirements of education or scope of practice for what defines these titles, and they cannot obtain an NPI number. If you want to use your health insurance to support diet and nutrition changes, you’ll want to look for an RDN. For more information on the difference between a Nutritionist, Health Coach, and Registered Dietitian Nutritionist, check out our article here.
The type of health insurance you have matters when it comes to what kind of coverage you may have. There are both public and private health insurance available. Public health insurance that would cover nutrition services includes Medicare Part B and Medicaid. Private health insurance can be purchased through the Healthcare Marketplace or is offered through employers.
Medicare Part B will only cover Medical Nutrition Therapy for Diabetes, Chronic Kidney Disease, and for a period following a kidney transplant. Unfortunately, individual nutrition counseling is not covered for pre-Diabetes, at this time. For dietary and nutrition support for pre-Diabetes there is a Medicare National Diabetes Prevention Program (MDPP) that is available in all states through approved suppliers. Click here for more information about the MDPP program.
Medicaid is available to individuals with low income who cannot afford health insurance otherwise. Each state has their own Medicaid program and rules for qualifications and coverage. In Oregon, there are several Medicaid plans available throughout the state. Asides from the Oregon Health Plan, there are regional Coordinated Care Organizations that offer services to OHP qualified recipients. Some Medicaid plans in Oregon will cover nutrition counseling for more health conditions than Medicare Part B, including general nutrition guidance, if the RDN is an In-Network provider.
Private health insurance plans are available either through the Health Care Market Exchange or through an employer. To find out if your health insurance plan covers nutrition services and dietary counseling, many plans have customer service phone numbers or chat features on their website to find out details of your plans. When speaking with your health insurance representative, some important questions to ask are:
Does my plan cover nutrition counseling? If they ask for a CPT code, Registered Dietitians typically use 97802 for initial consultations and 97803 for follow up sessions.
Does my plan cover obesity screening and counseling under the Affordable Care Act? **see below for more information about the ACA obesity screening and counseling provision.
Do I need a referral from my Primary Care Provider (PCP)? If you’re seeking nutrition counseling are for Diabetes, Chronic Kidney Disease, or other chronic health conditions, then you will need a referral from your PCP. Registered Dietitians are limited in the Diagnostic Codes they use to bill and are not allowed to use many codes without a referral from your PCP.
Do I need to have a medical condition to see a Registered Dietitian? If yes, you will need a referral from your PCP.
Do I need a pre-authorization to see a Registered Dietitian Nutritionist?
Are there any limitations or exclusions?
Does my deductible need to be met before Insurance will cover sessions? If so, are Telehealth appointments covered without the deductible having to be met?
Is there a difference in co-pays or co-insurance between seeing a Registered Dietitian in person or virtually?
If your insurance does cover Nutrition Services with a Registered Dietitian, look for an RD that is In-Network for your health plan. Many plans cover Nutrition Services, but only with In-Network providers. Out-of-Network providers may not be covered at all, or you may end up being billed for a large out of pocket co-insurance or co-payment. To find an In-Network provider, go to your health insurance companies’ website, log into your account, and then search for in-network providers for your specific plan.
Some health insurance plans will only cover Nutrition Services if your Deductible has been met. However, some plans have provisions that will cover Telehealth (virtual) appointments at 100%, or with a small co-pay, even if your deductible hasn’t been meet. Virtual appointments are frequently more convenient and as effective as in person sessions. HealthyU Nutrition and many RDNs offer both in person and virtual appointments.
**The Affordable Care Act Obesity Screening and Counseling**
The Affordable Care Act requires most health insurance plans to provide obesity screening and counseling with no copays or deductibles. This includes Medicare Part B, Medicaid, plans purchased through Marketplace, and some private health plans. To qualify for this benefit there must be a diagnosis of a BMI greater than 30, a PCP or RDN may determine BMI and if you qualify. There is no definition for what “counseling” means under the ACA, so you may be able to see an RDN or other health care provider in an individual setting or access a group program such as weight watchers. Reach out to your health insurance provider about the specifics of your plan and if you can see an RDN to utilize this benefit.
Why use health insurance rather than pay out of pocket? Using your health insurance does not increase your co-pay, deductibles, or premiums. It’s not like homeowners or vehicle Insurance where claims can increase your premiums. You likely already pay a monthly premium that covers these types of benefits. Out of pocket costs may be minimal with copays as low as $10 per session or covered at 100%.
HealthyU Nutrition accepts most plans (not all) through BlueCross BlueShield (Regence and Anthem), United HealthCare, Cigna, and PacificSource. We can also accept Medicare Part B, for qualifying conditions, as well as some Medicaid provides in Oregon, the Oregon Health Plan and PacificSource Community Soulutions.