Question 1

How does insurance work?

Accepted Answer

You can use insurance for one-to-one (face-to-face) session visits. We will bill your insurance company directly.

It is important YOU understand your insurance benefits because they are specific to your plan and your diagnosis. The policyholder should call the insurance company directly to get a clear picture of coverage.

Note: Please use this Verification of Benefits Form to guide you through the call with your insurance provider.

Question 2

What insurance companies does My Diabetes Nutrition participate with?

Accepted Answer

Currently, we are still working on getting credentialed with ALL Major Insurance companies such as – Aetna, Cigna, United HealthCare, and others.

We are ONLY credentialed with MEDICARE, BCBS, Aetna, Providence, United Health Care, PacificSource Health & Community (OHP), American Specialty Health, and First Choice Health at the time of this post.

Note: Medicare only covers the visit if you have Diabetes or Chronic Kidney Disease. Medicare DOES NOT cover nutritional counseling for pre-diabetes or obesity in an outpatient setting at this time. This is the same for your supplemental (secondary) insurance.

See the next FAQ for other insurance and how we can help you.

Question 3

What happens if My Diabetes Nutrition does not participate with my insurance?

Accepted Answer

We can provide you with a Superbill so that you can provide it to your insurance provider for possible reimbursement. Note this is not guaranteed and you must confirm with your insurance provider that you have coverage for Nutrition counseling.
Please follow the steps below ‘What questions should I ask when calling my insurance? Note: Please use this Verification of Benefits Form to guide you through the call with your insurance provider.

In the event, your claim is denied for lack of nutrition coverage:

Our Initial Visits (60-minutes) are $240.00
Each follow-up visit (30-minutes) is $120.00.
My Diabetes Nutrition LLC accepts cash, HSA/FSA cards, and all major credit cards.

We also have great payment plan options for both cash and insurance-based clients. Please read the details of each package for more details.

Question 4

I live far away, can I see a dietician virtually?

Accepted Answer

Most insurance are still covering for telehealth services. Therefore, when you schedule your visit you will be directed towards the next steps to setting up properly for your telehealth session. However, your insurance plan may impose a cost-share for you to use this service. Please call your insurance company to confirm your telehealth coverage PRIOR to scheduling your visit.

Note: Please use this Verification of Benefits Form to guide you through the call with your insurance provider.

Question 5

What questions should I ask when calling my insurance company?

Accepted Answer

Important: to avoid ANY surprise bills to the patient – Please note it is the patient’s responsibility to call their insurance company PRIOR to your visit to confirm coverage.

Note: Please use this Verification of Benefits Form to guide you through the call with your insurance provider.

Below are some of the questions that are in the Verification of Benefits form with further explanation for you.

Questions to ask:
Ask your insurance whether we (My Diabetes Nutrition LLC) are in-network for your specific plan.

Our group NPI is 1730957150 – My Diabetes Nutrition LLC
Individual NPI is 1982009742 – Melissa Ortiz
Our tax ID# is 66-0991577
If we are out-of-network, no problem! We can provide you with a superbill for you to submit to your insurance company for possible reimbursement.  The cost of the appointment will be collected from you at the time of the visit and you will be issued a reimbursement from the insurance company if they have coverage for this service. Oftentimes, you will receive a full refund.

Do I have nutritional counseling coverage on my insurance plan?

If the insurance company asks for a CPT code please provide them with the following codes 97802 & 97803.
If they say you do not have coverage using those codes NEXT ask them to check your coverage for the following CPT codes: 99401, 99402, 99403, and 99404. We also can bill for S9470 if it is covered by your policy.

Will my diagnosis be covered?

If the representative asks for a diagnosis code (ICD 10 code) – please tell them the visit is coded the ICD 10 code: Z71.3
If they don’t accept Z71.3 then provide them with Z72.4 and see if they will cover that diagnosis instead.
If you have overweight, obesity, pre-diabetes, diabetes, hypertension, or high cholesterol you may want to see what your coverage is for these diagnoses as well.
We always code your visit using preventative coding (if applicable) to maximize the number of visits you receive from your insurance carrier. **However, if you ONLY have a medical diagnosis (for example: IBS, and you are not overweight or have CVD risk factors) your insurance may impose a cost-share for your visit either in the form of a deductible, co-pay, or co-insurance.

How many visits do I have per calendar year?

Your carrier will let you know how many visits they are willing to cover. Depending on the carrier the number of visits varies from ZERO to UNLIMITED depending on your medical need.

Do I have a cost-share for my nutrition visit?

A cost-share is the amount you will need to pay as required by your particular insurance plan towards your services. A cost-share can be in the form of a deductible, co-pay, or co-insurance.
We will always bill under your insurance policy’s plan under your preventative benefits if your plan allows it. With that being said, if you have preventative benefits there is often NO cost share for you associated with the visit.
In the event you have a cost-share we will initially bill your insurance company directly.  Once we receive the EOB (Explanation of Benefits) describing your responsibility as the patient, we will bill the credit card on file for the amount noted under ‘patient responsibility.
For most insurance companies dietitians are considered specialists. Therefore, your specialist co-pay is applicable and is payable at the time of service. This information is often apparent on the front of your actual insurance card. However, often because we bill your insurance with preventative counseling the co-pay is often not applicable.
We generally wait for the claim to be processed to determine whether or not you have a co-pay and then charge the credit card you have on file with us the co-pay amount.

Do I need a referral to see a Registered Dietitian?

Is there an associated cost for me if I choose to have the appointment as a telehealth visit versus an in-person visit?

Question 6

What are the services not covered by insurance?

Accepted Answer

Listed below are services not covered under current health plans but might be recommended by your provider/dietitian or requested by you:

Service	Cost	Quantity	Total Cost
Weekly Check-ins/Chat	$860	1	$860
HTMA (included)	$150	2	-$300
GIMAP	$375	0	0
3 Day Meal Plan	$200	0	
Total Cost of Non- Covered Services $860

Question 7

Description of the services not covered by insurance.

Accepted Answer

Weekly Check-ins/ Chat – Get access to your dietitian through a secure chat service Monday through Friday (except holidays) 9 am – 4 pm PST, through the duration of the 3-month program. Receive feedback on your assessments, Blood Glucose Monitor Logs, Daily meal log reviews (Valued at $3,000)

HTMA Test, Results, and Recorded Video Review of your lab results, recommendations, and how to move forward in your health goals. ($350 Value each)
–    Hair Tissue Mineral Analysis (HTMA) is a non-invasive hair test that assesses mineral levels and imbalances in the body (beyond blood work). Mineral imbalances can influence insulin sensitivity, blood sugar regulation, sleep, appetite, mood, energy, digestion, menstruation, hormones and so much more!

GIMAP Test, Results, and Recorded Video Review of your lab results, recommendations, and how to move forward in your health goals. ($500 Value)
–    A GI-MAP, or Gastrointestinal Microbial Assay Plus, is a type of functional testing that assesses the health and composition of the gut microbiome. It is commonly used in functional medicine to provide insights into the balance of bacteria, viruses, parasites, and other microorganisms in the gastrointestinal tract. An imbalanced gut microbiome can have a significant impact on various aspects of our health potentially causing digestive issues, immune dysfunction, improper nutrient absorption, dysregulated metabolism, and difficulty with weight management, it can cause mental health issues such as anxiety, and depression, even skin issues like acne, eczema or psoriasis, also allergies, autoimmune disease, mood and sleep changes.

3-Day Meal Plan – Detailed and tailored plan to your nutritional and unique needs. Incorporating nutrients and minerals that you could be either lacking or deficient in. Foods that will help move the needle in your desired health goals.

If additional costs arise for ongoing care or new labs, that will be discussed between the provider/dietitian and the client prior to any additional billing being completed.

Question 8

I still have questions!

Accepted Answer

If you have any questions after verifying your benefits we are happy to help. Please email Melissa Ortiz at Melissa@MyDiabetesNutrition.com  We will return your message within 48 business hours.

HTMA

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