To get started, complete these 3 steps!

To get started, we advise that you call your insurance company PRIOR to your visit to confirm coverage. This is the patient’s responsibility; we will provide an estimate of coverage, but it is not guaranteed to be accurate until the claims have been processed.

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 on 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 with 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 of your plan. 

• If you are overweight, obese, have 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. 

Is the dietitian a provider with my insurance plan?

• Provide Almarie Talavera’s NPI (1427835222) to ensure you can receive insurance-covered care from her.

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 0 to unlimited, depending on 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 plan, using your preventive benefits if your plan allows. With that being said, if you have preventive benefits, there is often no cost share associated with the visit. Once again, this is something YOU do want to ask before your visit. 

• If you have a cost-share, we will initially bill your insurance company directly.  Once we receive the EOB 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 a specialist. Therefore, your specialist co-pay is applicable and must be paid 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 you have a co-pay, and then charge the credit card on file with us the co-pay amount.

Summary of questions to ask to verify your nutrition benefits

• Do I have coverage for nutrition counseling?

• Do I need a referral to see a Registered Dietitian?

• Are my diagnoses covered on my particular plan?

• Is the dietitian a provider for my insurance plan?

• How many visits per calendar year do I receive?

• Do I have a cost-share for these services?

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