Nutritionists/Dietitians and Health insurance

[fernweh]

Are they typically covered. I did a Google search that said the Affordable Care Act mandates nutritional services are covered. I can’t find anything on my insurance coverage page about it being covered.

My dr recommended I start working with a RD but I want to make sure my insurance bases are covered first.

Is it covered (I know coverage varies just trying to get a general idea)? Is my insurance company trying to hide benefits? I will call later - just curious if others have first hand experience with it.

[7costanza]

It was covered for me in 2021 when I was pre-diabetic.

[akayf]

We just went through this with DH. He’s pre-diabetic. His dr referred him to one that luckily was in network. She checked with insurance before the first appointment because some policies set a cap on the number of visits. He wound up only needing 1 visit. We had to pay $150 since we hadn’t met the deductible yet but that was the only out of pocket expense. If he needed additional visits, we wouldn’t have had any additional out of pocket expenses.

[klee23]

I'm sure you called today already and have an answer specific to your policy. I work home health currently and have to have patients sign a financial agreement (acknowledgment) of deductible, copays, co-ins etc. RD is one discipline we can offer and numerous policies are listed as "covered for allowable diagnoses" and many are not covered, very few are covered outright. I don't know how that plays off the ACA but it's what our insurance department has unraveled.

[dcrunnergirl52]

It can be covered but my experience is that it's for a very strict set of reasons. My United plan only covers it for "Diabetes, Coronary Artery Disease, Congestive Heart Failure, severe Obstructive Airway Disease, Gout, Renal Failure, PKU, Hyperlipidemia."

I've been fighting with them for almost a year now to cover my DD's visits to a nutritionist after she had some health challenges and lost 30lbs in 4 months and desperately needed to regain weight. It has been infuriating.

[sadlebred]

In 2022 it was covered for medical reasons. I got 1 visit.

[cuadrado]

It depends on the health insurance plan. Some plans only cover minimal visits and some plans provide unlimited. 

It's kind of backwards but some plans provide unlimited nutrition coverage for the diagnostic code z71.3 which is basic nutrition counseling (falls under preventative healthcare) but then don't provide coverage for an actual medical diagnosis. 

You would want to see if your insurance covers CPT codes 97802 initial nutrition assessment and 97803 follow-up assessment and then which diagnostic codes are covered.

[definitelyO]

you should be provided with a Summary of Benefits and Coverage and a Plan Document from your employer. the SBC is required to be provided. you can search the Plan document to review if and how covered.

love cuadrado, details on this!

[dcrunnergirl52]

Nov 22, 2023 9:00:18 GMT -5 cuadrado said:

It depends on the health insurance plan. Some plans only cover minimal visits and some plans provide unlimited. 

It's kind of backwards but some plans provide unlimited nutrition coverage for the diagnostic code z71.3 which is basic nutrition counseling (falls under preventative healthcare) but then don't provide coverage for an actual medical diagnosis. 

You would want to see if your insurance covers CPT codes 97802 initial nutrition assessment and 97803 follow-up assessment and then which diagnostic codes are covered.

This is the issue that I've run into. The online claim form doesn't allow me to submit under either of those CPT codes. United says it's a glitch with their system and I need to submit paper forms, which is ridiculous. They also say they are going to deny my claims b/c they don't accept sessions that are filed as multiple units (they code the appointments as 1 unit = 15 minutes, so each session is like 3 sessions), so I need to file and then they will deny and they might accept on appeal. It's a huge PITA. So, all that to say, I think insurance does the most to avoid covering nutritionists.

[Jalapeñomel]

Mine covers it for anyone