Verify Your Insurance Coverage
for Nutrition Appointments
While most health insurance plans cover nutrition services, it is best to first check the coverage of your individual plan. For appointments that insurance does not cover, payment become the client’s responsibility. Please use the below script when calling your insurance company to verify your specific plan’s nutrition coverage. Please note that verifying your benefits does not guarantee coverage, as insurance company representatives at times misquote benefits, however verifying benefits greatly reduces the chances of surprise medical bills.
If you would like us to verify your benefits for you, please email us at firstname.lastname@example.org with “Verify My Benefits” in the subject line after booking your appointment. The charge is $15 for us to verify your benefits on your behalf.
Phone Call Script for Verifying Your Own Insurance Coverage:
Generally the back side of your insurance card will list a phone number that you can call to verify benefits. When speaking to a representative at your insurance company, ask the following questions and write down all the answers:
Does my insurance plan cover nutrition counseling?
- If the representative asks for a CPT code, provide them with CPT codes 97802 and 97803.
- If they say you do not have coverage using those codes, then ask to them to check your coverage for CPT codes: 99401, 99402, 99403 and 99404.
Will my diagnosis be covered?
- If the representative asks for a diagnosis code, tell them the ICD 10 diagnosis code is z71.3
- If they don’t accept z71.3, then provide them with code z72.4 and see if they will cover that diagnosis instead on your plan.
- If you are considered “overweight”, “obese”, have pre-diabetes, diabetes, hypertension, or high cholesterol you may want to see what your coverage is for these diagnoses as well.
Is Caylee Clay an in-network provider?
- This is to verify that Caylee is in-network with your specific plan.
- If they ask for Caylee’s NPI (National Provider Identifier), then provide them with this number: 1508410556.
How many appointments are you covered for per calendar year?
- Ask how many appointments per year your plan covers. It can range from zero to unlimited.
Are the appointments considered preventative? If not, have I met my deductible?
- If you are told that your copay is $0 and deductible is $0, then the appointment is considered preventative.
- There is a chance that your plan may only have medical coverage (not preventative), and the representative will tell you a dollar amount for your copay and deductible. In the event you have a deductible, your insurance company requires us to charge the full amount for your appointments. In this case, a payment of $199.00 is due at the initial visit, and $119 is due at each follow-up visit.
- Note that we do not collect copays until after your appointment, when the insurance company informs us whether or not we need to charge you a copay.
Are telehealth appointments still being covered?
- If you would like your appointment online over video, confirm that your plan is still covering telehealth services.
Are there any exclusions or prior authorizations required?
- Ask if there are any exclusions to your visit, for example a patient must have diabetes or obesity in order to be seen.
- Is a prior authorization or referral needed for your visit? If so, who can provide the referral, or does it need to be the primary care doctor? How do you go about getting prior authorization – is there a phone number or is it done online?
Ask for and write down the call reference number
- Ask the representative to provide the reference number for the call.