Checking Insurance Benefits

We are excited to work with you and value making care more accessible by being in-network providers with insurance.

To best help you understand your insurance benefits, we recommend calling the "member services" phone number on the back of your insurance card and ask the questions listed below.

We are 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 (procedure) codes: 97802 and 97803

    • If yes, how many sessions are allowed per calendar year?

  • If you are asked for a diagnosis code-

    • If you have been diagnosed with an eating disorder, you can provide that code (example: F50.9, Eating Disorder, Unspecified)

    • If you have been diagnosed with pre-diabetes, diabetes, hypertension or high choletserol you can check your coverage for these conditions

    • Please Note: As a weight inclusive providers, we disagree with the use of BMI as a proxy for health. That being said, sometimes insurance will cover services at no cost to you if your BMI is >25.

      • If you meet this criteria, you can ask about coverage for preventative benefits for nutrition counseling

    • If you do not have a diagnosis as listed above, or if you are uncertain about what applies to you, you can check your coverage for the diagnosis code for R63.30, Z72.4, or Z71.3

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?

  • When does my deductible reset?

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

4. Obtain doctors referral.

  • Before scheduling/attending your initial nutrition counseling, we recommend requesting a doctors referral for nutrition counseling to allow us to bill your insurance for services. This referral can be faxed to 412-332-0025.

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​​Please note: If an insurance claim is denied, we will do our best to troubleshoot, however, 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 (medical nutrition therapy and/or preventative benefits for nutrition counseling)

  • Are my diagnoses covered on my particular plan?

  • How many visits per calendar year do I receive?

  • Do I have a deductible, co-pay or co-insurance for these services?

We are out of network with:

Medicare

Medicaid

United Health Care

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