Insurance

Can I use insurance for my nutrition visit? 

Yes! Most health insurance companies cover nutritional counseling!

 

This is often the case even if you do not have an actual diagnosis, but still want to come in for nutrition counseling for prevention of disease. 

 

You need to call to verify and confirm you have benefits on your insurance policy for nutritional counseling (see below for details). 

What Insurance Companies Does Kontaxes Nutrition Participate With?

Currently, Kontaxes Nutrition is in network with Aetna, Highmark Blue Cross Blue Shield, and United Healthcare.

Verifying Your Benefits

What to ask when you call

Clients are responsible for verifying their own coverage and benefits with their insurance plan. PRIOR to your appointment, call the number on the back of your card and ask them the following questions (You can also use this FORM when calling which outlines everything in more detail):

 

Do I have nutrition counseling coverage on my insurance plan? 

  • 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, 99404. I can also bill for S9470 if it is covered on your policy. 

 

Do I need a referral to see a Licensed Dietitian Nutritionist? 

  • Most insurances do not require a referral, but you need ask to your insurance company to find out their requirements. 

 

Will my diagnosis be covered? 

  • If the representative asks for a diagnosis code (aka ICD 10 code), please tell them the visit is coded with the ICD 10 code: Z71.3.
  • If they don’t accept Z71.3, then provide them with Z72.4 and see if they will cover that diagnosis on your plan. 
  • Please ask if you have both preventative and medical nutrition services on your policy. 
  • If you are overweight, obese, have pre-diabetes, diabetes, or high cholesterol you may want to see what your coverage is for those diagnoses as well (ask your doctor for these ICD 10 codes).
  • I always code your visit using preventative coding (if applicable) to maximize the number of visits you receive from your insurance carrier. However, if you ONLY have a medical diagnosis your insurance may impose a cost-share for your visit in the form of a deductible, co-pay, or co-insurance. 

 

How many visits do I have per calendar year? 

  • Your insurance company will let you know how many visits they are willing to cover. Depending on the insurance company, the number of visits vary from 0 to unlimited depending on the medical need. 

 

Do I have a cost-share for my nutrition visit? 

  • A cost-share is the amount you will need to pay as required by your particular insurance plan towards your services. A cost-share can be in the form of a deductible, co-pay or co-insurance. 
  • I will always bill under your plan’s preventative benefits if your plan allows. If you have preventative benefits, there is often NO cost share for you associated with your visit. This is something YOU do want to ask prior to your visit. 
  • In the event you have a cost-share, I will initially bill your insurance company directly. Once we receive the EOB describing your responsibility as the patient, I will bill the credit card on file for the amount noted under ‘patient responsibility.’
  • For most insurance companies, licensed dietitian nutritionists are considered a specialist. Therefore, your specialist co-pay is applicable and is payable at the time of service. This information is often apparent on the front of your insurance card. However, often because I bill your insurance company with preventative counseling, the co-pay is often not applicable. 
  • I 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 for the co-pay amount. 

 

Is there an associated cost for me if I choose to have the appointment via telehealth instead of in person? 

  • Even if you anticipate always meeting in person, it is a good idea to check if there is an extra cost for a telehealth visit incase at some point during our time working together, there is a need for a telehealth visit. 

 

Summary of questions to ask to verify your nutrition benefits:

  • Do I have coverage for nutrition counseling?
  • Do I need a referral to see a Licensed Dietitian Nutritionist?
  • Are my diagnoses covered on my particular plan? 
  • How many visits per calendar year do I receive? 
  • Do I have a cost-share for these services? 
  • Is there an associated cost for me if I choose to have the appointment as a telehealth visit versus in person visit? 

 

It is very important to get the name of the representative that you talk to and a reference number for the call. 

Sessions are held:

In Person at: 


1047 Allegheny Ave 

Oil City, PA 16301 


Or


Virtually, via a HIPAA compliant platform