We accept the following insurances only:

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Aetna, most Blue cross blue shield plans, Medicare. If you have another insurance- Payment is out of pocket and we can give you a superbill to submit to your insurance. You may have out of network benefits for nutritional counseling.

 

Step 1:

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

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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.

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  Step 2: 

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

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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:​​

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• Aetna-Can allow anywhere from 3, 12 or 22 visits/year depending on diagnoses. Z71.3 (general nutritional counseling) is not a covered diagnoses​

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• 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.

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• ​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. 

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• ​Other Blue Cross Blue Shield plans- Out of state- coverage varies greatly- visits can be 3 to unlimited depending on plan and diagnoses

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  Step 3:

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  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 258 Broad Street, Red Bank, NJ, 07701

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.

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For Insurance Companies Not Listed Above: ​

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If your insurance is not listed above and/or you do not have nutritional counseling benefits please refer to the prices listed above. We will provide a receipt for the service provided and you can send to your insurance for reimbursement. Except for Medicaid. 

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For individuals with Medicaid, we do not accept Medicaid.