Will my insurance cover your services?
Are Nutrition Visits Covered?
Yes, usually!!! And often with no cost to you!
And then, sometimes no, they’re not covered. It depends on your plan!
Below you’ll find all the details about insurance and nutrition counseling.
Insurance We Accept!
We currently accept Blue Cross Blue Shield, United Healthcare, Cigna, Aetna, Medicare, FSA/HSA, as well as private-pay. For clients with out-of-network coverage we provide a superbill (receipt) following services. The superbill allows you to seek reimbursement for your care directly from your insurance company.
Blue Cross and Blue Shield (includes Anthem and all other BCBS plans): Often covers our services with NO COPAY! Federal plans have unlimited visits, state plans have 7 hours per year with no copay, and many commercial plans cover us well too.
United Healthcare Plans (includes Bind / Surest, Student Services, UMR, KanCare and more): Often covers our services with NO COPAY and visits are often unlimited! (depending on the diagnosis) Wichita Public Schools employees are usually covered with no copay and unlimited visits.
Cigna: Often covers at least 3 preventative visits each year with NO COPAY, some plans are unlimited visits, often covers eating disorders as well.
Aetna & Meritain: Often covers us well with unlimited visits with NO COPAY. Contact us today to learn more. We are not covered by Aetna Better Health Plans.
Medicare: Has good coverage if you have diabetes or kidney failure. Medicare currently does not cover for any other diagnoses. We are not currently taking on Medicare clients.
United Healthcare KanCare - Medicaid: We currently only accept United Healthcare Medicaid & at this time coverage is for those 20 years & younger. If you are a person who has an eating disorder and cannot pay for care, please contact Project Heal.
Insurance We DO NOT Accept.
We are NOT credentialed with Ambetter, Sunflower Medicaid, Aetna Better Health, ProviDRs Care. We can provide a receipt (superbill) for you if you have out of network coverage.
Even if you do not hold an insurance we’re in network with, you may still seek reimbursement from your insurance company with your out of network coverage, if you have it. (We’ve had clients get 100% coverage for out-of-network care for some of their sessions.) When you call your insurance company, you’ll want to ask about out of network benefits for nutrition counseling.
For clients with out of network coverage, you will pay cash for services. We will send you a receipt (superbill), that you submit to your insurance, and they’ll reimburse you directly for any services for which you have out of network coverage.
Knowing Your Insurance Benefits is YOUR Responsibility!!
To avoid financial surprises, please do not assume nutrition counseling is covered.
We do not verify benefits. It is your responsibility to know your coverage.
We give you the tools so that you know how to check benefits…read on! However, you are responsible for any service received that insurance does not cover.
While we provide you with all the questions you need to ask your insurance here, we’re also happy to answer questions you might have. We know it’s confusing!
How can I make this easy?!?!
Below are directions on checking your insurance benefits, which can give you an idea of how services will be covered.
The reality is that we never truly know what insurance will cover, even if we talked to an insurance rep for verification, until we have submitted an actual visit.
If you want to simplify this process…
Complete an intake visit and we’ll bill your insurance to see how they’ll pay. After they make a determination on the first visit you’ll have a better idea of how they’ll cover. Based on that, you can decide if you want more visits or not.
If you choose this option and insurance doesn’t cover, the most you might owe is the cost of an intake session.
Ready to schedule? You can do that on our scheduling page!
How do I check my insurance benefits?
First, know that Nutrition visits are covered in one of two ways…
PREVENTIVE NUTRITION COVERAGE: Even without a nutrition diagnosis (such as diabetes), many insurance plans cover preventive nutrition visits. These visits are covered at no cost to the client!
Dietitians are often, but not always, able to code visits for preventive benefits without a referral. This is true for Blue Cross Blue Shield plans and many United Healthcare / UMR plans, depending on your diagnoses.
MEDICAL NUTRITON THERAPY COVERAGE: If you do not have preventive nutrition coverage, but do have medical nutrition therapy benefits, you will need to have a referral from your doctor or therapist for us to bill your insurance. Dietitians do not diagnose many medical conditions. This includes diabetes, high cholesterol, eating disorders, etc.
Next, know the questions to ask…
Hint: The questions to ask your insurance will make more sense after reviewing the difference between PREVENTIVE and MEDICAL nutrition coverage above. We recommend taking a minute to go back & review those if you didn’t already.
Checking insurance benefits can be simple. We recommend you grab a piece of paper to take notes on. Bring your notes to your session so we can be sure to code your visit in the best way for optimal use of your benefits.
We’re also happy to call your insurance company with you in your session, if that is helpful. However, you are responsible for all costs your insurance does not cover.
Below are the general questions for checking insurance with each company. When you reach out to us, as part of your intake paperwork, we’ll send you these questions with coding for your particular insurance company. You’ll be able to enter the answers & the reference number in our system, and if it’s needed in the future we’ll send it to you.
Having this info saved in our system has been helpful to our clients even up to 1 1/2 years after they completed services, when insurance took all of the payments back from us & the client had a big bill. Yep, we’re advocates & will help you as much as we can!
We’re here to help & support you with everything we know about insurance. However, we can never guarantee payment.
When you’re ready to call…
Below are general questions to ask. If you prefer to get the form with specific questions for your insurance company prior to calling, please fill out the inquiry form.
Get a pen & paper to record notes and a reference number for you call.
Call the customer service number on the back of your card. Once you have a rep on the phone ask them the following questions & take notes:
Do I have coverage for nutrition counseling under my PREVENTIVE benefits? (You can tell them we usually use CPT codes 97802 initial and 97803 follow-up.)
If I have PREVENTIVE coverage, are there any limits for my PREVENTIVE nutrition benefit?
Do I have coverage for nutrition counseling under my MEDICAL benefits?
If yes, are there any limits for the MEDICAL nutrition benefits on my plan?
Is a preauthorization required to use my nutrition counseling benefits?
Is a referral required?
(If no referral required by insurance, contact Sunrise Nutrition. You may not need a referral for insurance coverage, but you could still need a referral for the dietitian to use your diagnosis code. Let us help, it’s confusing!!)
Do I have a deductible, copay, or coinsurance I’m responsible for?
Is telehealth covered?
When my insurance year renews, do these benefits also renew? If yes, what is my insurance year?
What is the reference number for this call? (Get a reference number! If they say you have benefits and then do not pay, you can call back with this reference number.)
If you don’t like the answer you got from the rep, or they didn’t sound like they were sure, call back!
We find that different reps give different answers. (Ugh, I know…this is the reality of insurance!!)
And sometimes clients are told no they don’t have benefits, but we always bill the first visit anyway to see what happens. And…YES, services are often covered even though the rep said no. This is the headache, and beauty, of insurance!
Important notes if you have PREVENTIVE coverage on your plan.
Blue Cross Blue Shield Plans
You usually don’t need an applicable diagnosis to receive the PREVENTIVE benefits on Blue Cross Blue Shield plans. PREVENTIVE benefits are usually “tripped” using a generic nutrition code and no referral is needed. For those under 18 to receive the PREVENTIVE benefit they have to be overweight. Adults at any size can receive their PREVENTIVE benefit. (I know, insurance drives us nutty too!)
United Healthcare / UMR / Surest / etc.
You must also have an applicable diagnosis to receive PREVENTIVE benefits. Your insurance rep can tell you if your current diagnoses is covered. Some of these codes can be used without a referral (BMI codes), however, others can’t, and there are many. Your provider (Primary Care Provider or Therapist) will need to send us a referral prior to your session, or backdated prior to your first session. Call us if you have questions about what needs to be on a referral. If you believe your provider will backdate a referral, we can also discuss this in your first session.
Aetna / Meritain
Similar to United Healthcare, there are many applicable diagnoses. It’s best if we discuss your personal situation, and let you know if a referral is needed. Often a referral is not needed, but sometimes it is, so please ask!
Cigna
We’ve had fewer clients with Cigna so we are still learning about their coverage. We’ve had clients with 3 PREVENTIVE visits per year and others with unlimited PREVENTIVE visits. Completing an insurance verification will help you to know about your plan.
Medicare
Medicare currently does not have PREVENTIVE coverage. Medicare only covers for diabetes (NOT prediabetes) and kidney failure.
Other Helpful Details
Insurance Coverage for Nutrition Counseling and Eating Disorders, including Binge Eating Disorder.
Eating Disorders are required by law to be covered by insurance (see the Mental Health Parity & Addiction Equity Act of 2022). If your insurance covers nutrition for diabetes, they MUST cover for an eating disorder! Ensure your doctor puts an F code on the referral (not the R code as it often doesn’t cover / isn’t the correct diagnosis). Many of our clients have advocated for fair coverage that the law requires!
Yay! My insurance covers!! What do I do now?
…or maybe you just want to do an intake visit & see what happens with insurance coverage.
Once you’ve used the questions above to learn about your coverage, if that’s important to you, please complete the appointment inquiry form. We’ll send you our intake paperwork and get you scheduled.
Ready to schedule, or want our Insurance Verification questions for your insurance sent directly to you? Contact us today!
Look, we know insurance is confusing!! We’ve been at this a long time & are still learning.
Reach out with any questions!
Email, Call / Text 316.217.2984