Checking Insurance Benefits

Please note that it is your responsibility to call your insurane company prior to your Initial Counseling Session to confirm coverage. This will reduce the likelihood of any surprise bills or unexpected charges.

You can verify your benefits by calling the "member services" phone number on the back of your insurance card, the questions listed below can help you to understand your coverage & benefits.

In network with:

Aetna

Cigna

Highmark Blue Cross Blue Shield

UPMC Health Plan

  1. Does my plan cover outpatient nutrition counseling & Medical Nutrition Therapy?

  • CPT codes: 97802 and 97803

    • If yes, how many sessions are allowed?

  • CPT code: s9470 (if you have UPMC insurance)

    • If yes, how many sessions are allowed?

  • Does my plan only cover visits that are "medically necessary?"

    • If yes, is there a medical policy that this applies to?

    • Do I need a referral from my physician?

  • Does my plan cover preventative services for Diagnosis code: z71.3?, If not, z72.4?

    • If yes, how many sessions are allowed?

  • Note: We will always code your visit using preventative coding (if applicable) to maximize the number of visits you receive from your insurance. Exceptions may include a medical diagnosis (for example: Eating Disorder, Type 2 Diabetes, Celiac Disease). You can also ask your insurance company about coverage for these diagnoses, if applicable to you.

2. Do I have a deductible or out of pocket amount to meet first?

  • If yes, how much is my deductible or out of pocket amount?

  • How much have I met of my deductible or out of pocket costs?

  • Do I have a copay or coinsurance? If so, what is the percentage or amount?

3. Obtain a reference number for your call.

  • Before ending your call with the representative, it is strongly encouraged to obtain a confirmation or reference number as well as the representative's name who helped you. This information will come in handy should there be an issue with the claim processing

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​​Please note: If an insurance claim is denied, it is your responsibility to pay the remaining balance.

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 Registered Dietitian?

  • 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?

Out of network with:

Medicare

Medicaid

United Health Care

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