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Insurance Guide to In-Network Benefits

We are a membership based practice. IF you have nutritional counseling benefits with insurance, those visits can be APPLIED to your membership. Please use the guide below when calling your insurance company to verify if you have Nutritional counseling benefits and how many visits you have per year. Root Health Nutrition and Wellness does not verify insurance benefits for patients. 

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How To Verify Your Insurance Benefits: 

  (Please note that the amount of visits covered will go TOWARDS your membership package.  Example: If you have 3 visit covered/year- the cost of the 3 visits will be deducted towards your annual membership (the membership includes 7 visits with an RD).

We accept the following insurances:

Aetna, most Blue cross blue shield plans, Medicare. (Medicare only covers Diabetes or kidney disease)

 

If you have another insurance- The complete cost of membership is self pay. For each of the 7 individual visits,  you will be provided a superbill to submit to your insurance. You may have out of network benefits for nutritional counseling in which your insurance may reimburse you. 

How to call your insurance about nutritional counseling visits:

 

Step 1:

  When you get on the phone with an insurance representative ask the following: 

  1. "I am calling to see if a certain CPT CODE  (97802 (Initial Visit) and 97803 for the follow up visits) is covered under my plan?"

  2. "Is the Nutritional Counseling considered preventative?" If so, which diagnosis codes does that include?

  3. "Do I need a medical diagnosis to be covered under my plan?"

    • If so, please be sure to obtain a diagnosis code from your medical provider, or use some of the following examples associated with the reason for your visits:

      • Obesity: E66.9, overweight: E66.3, Morbid obesity: E66.01

      • High Cholesterol: E78.5

      • Diabetes: E11.65

      • Eating Disorder: F50.9

      • Mixed Irritable Bowel Syndrome: K58.2

      • General nutritional counseling, preventative: Z71.3  Aetna also does not accept this code. For Aetna- Z71.9 may be accepted or you will need a diagnoses code to be covered for nutritional counseling.  Medicare also does not accept this code.

  Step 2: 

  If you are covered, please also ask these additional questions: 

  1. How many visits allowed per year?  (Typically these are the allowed visits- You will need to call your insurance to verify exact coverage- all plans are different and vary depending on diagnoses.) The following insurance providers listed we are in-network with:​​

  • Aetna-Can allow anywhere from 3, 12 or 22 visits/year depending on diagnoses. If there is no diagnoses you can try asking about z71.9 (general counseling)

  • Medicare- 3 hrs/year for the first year and 2 hrs for the following year for only Diabetes or kidney disease. Please note: Under Medicare's policy: Nutritional Counseling is only covered if you have a diagnosis of Diabetes or Kidney Disease  in an outpatient setting. A referral is required from your provider prior your first visit. We are unable to see you without a referral prior to your first visit.

  • Horizon Blue Cross Blue Shield of NJ- 3 visits/year for all diagnoses accept eating disorder- typically unlimited visits- the diagnoses needs to come from a therapist or MD. 

  • Other Blue Cross Blue Shield plans- Out of state- coverage varies greatly- visits can be 3 to unlimited depending on plan and diagnoses. Some out of state do not cover nutrition services.  

  Step 3:

  Other questions to ask:

  1. Do I have to meet a deductible first?

  2. Is there a copay and/or what % of the service is covered?

  3. Are virtual and in person appointments covered?

  4. Is there a referral or pre-authorization needed?

  5. Provide our office information- Erin Falco RDN INC at 39 Sycamore Ave. Little Silver, NJ 07739

  6. Ask for the reference number of your conversation with your insurance company. THIS IS VERY IMPORTANT!

  7. Be sure to provide our office with the reference number you obtained when calling to schedule your first appointment - you will need this number in case your visit gets denied.

For individuals with Medicaid, we do not accept Medicaid.

Ready to Get Started?

Book a free 15 minute discovery call to discuss how our team of RDs can help your specific goals!

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