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Your insurance policy may cover Nutrition Counseling

Effective March 2020: Until further notice, all Nutrition visits are conducted virtually, via Telehealth, in the comfort of your own home or office, using a HIPAA compliant video platform.

Did you know many health insurance companies now cover nutritional counseling, also known as  Medical Nutrition Therapy? This is often the case EVEN if you don’t have an actual medical diagnosis BUT simply want to meet with a Registered Dietitian Nutritionist to help prevent future health conditions.  Telehealth visits are also covered.

I encourage you to call your insurance and ask if they will cover nutrition counseling, so that you can receive the benefits you are entitled to. Start by calling the 1-800 number on the back of your insurance card and ask to speak with a representative.

The following information will walk you through the steps to take to see if your insurance will cover the cost of nutrition counseling for your visit.

What insurance companies does Dr. Mary participate with?

Dr. Mary Friesz is currently a nutrition provider with Medicare, Horizon Blue Cross and Blue Shield, AmeriHealth, United HealthCare and Cigna.  Medicare ONLY covers Nutrition Counseling if you have Diabetes (Type 1 or Type 2) or some form of Kidney disease. Medicare DOES NOT cover for nutritional counseling for pre-diabetes at this time.

*Please note you are responsible for verifying nutrition counseling services covered on your plan.

What happens if Dr. Mary does not participate with my insurance?

If you have insurance with a company not listed above, Dr. Mary would be considered out-of-network.  In this situation, she will provide you with a “Superbill” and/or an itemized invoice you can submit to your insurance company for reimbursement. Reimbursement is based on your policy’s standards. Please call your insurance company’s member services number to verify how reimbursement works under your current insurance policy.

Please note if you do have insurance which considers Dr. Mary as out-of-network, Dr. Mary cannot submit directly on your behalf – she can only supply you with the appropriate paperwork. Therefore, payment is due at the time for service directly payable to Dr. Mary Friesz.

What questions should I ask when calling my insurance company?

Do I have nutritional counseling coverage on my insurance plan?

If the insurance company asks for a CPT code, please provide them with codes 97802 & 97803. If they say you do not have coverage for these codes, ask them to check your coverage for these CPT codes: 99401, 99402, 99403 and 99404.

Will my diagnosis be covered?

If the representative asks for a diagnosis code and you do not have any medical conditions – please tell them the visit is coded the ICD 10 code: Z71.3 or Z72.4.

If you have diabetes, gestational diabetes, hypertension, high cholesterol, kidney disease, celiac disease and/or are obese or morbidly obese, the good news is that most insurance companies will cover nutrition counseling for these conditions.  Please click here for the ICD-10 codes commonly covered for nutrition counseling.

How many visits do I have per calendar year?

Your insurance carrier will let you know how many visits you are entitled to. The number of visits vary, depending on your insurance policy and your medical need.

Have I met my deductible?

In the event you have a deductible I will not be able to bill your insurance company directly. Therefore, payment of services is due at visit.  I will, however, provide you will the appropriate documentation to submit to your insurance company to show receipt of the services. This will allow you to “pay down” your deductible.

Do I have a co-pay for nutritional counseling?

For most insurance companies I am considered a specialist. Therefore, your specialist co-pay is applicable and is payable at the time of service. This information is often listed on the front of your actual insurance card. However, in the event your insurance does not cover nutrition counseling, you would be responsible for full payment of the session, without an additional co-pay.  

Still have questions?  Feel free to email Dr. Mary!