For wellness professionals, helping clients make the most of their covered insurance benefits allows them to receive quality healthcare at an affordable rate. However, covered benefits not only vary amongst insurance payers, they also vary client-to-client. These variances in coverage make it difficult for wellness professionals (and clients), to accurately detect if services, such as nutrition counseling sessions, are covered for each prospective client.

Verifying client benefits prior to an initial consultation provides the following information:

• If a client is covered for your wellness services
• If a referral is required  
• If there are any client-owed responsibilities (ie. copays, deductibles, co-insurance amounts)

Although many wellness practitioners will verify insurance benefits on behalf of the client, it is ultimately, your client’s responsibility to fully understand the terms of their insurance benefits. It’s best practice to have your client call their insurance provider directly to verify their benefits, before their initial consultation. This can help reduce the number of clients who receive your wellness services, only to later learn that they were not covered (or fully covered) by their insurance.

Clients can verify their insurance benefits by calling the member services number located on the back of their insurance card. It should only take them ten minutes to determine their benefits, but they should be prepared for any hold times.

Is this nutritionist covered by my insurance?

When clients call their insurance providers, they typically only ask one question: am I covered to see [provider name]? While this will confirm that you are an in-network provider, it leaves out important details regarding their insurance coverage, and client responsibilities. Informing your clients which questions to ask will ensure that relevant information is captured.

Many wellness professionals list the following insurance questions on their website, located on their services page. This way, prospective clients can be prepared, and verify their benefits, prior to booking an initial consultation. Before your client hangs up the phone, they’ll want to obtain and document a reference number for their call. This call can be referred to in the case where a client’s claim is processed differently than what were outlined in the client’s benefits details.

Here are a few questions to help your clients learn the extent of their coverage:

1. Am I covered for nutrition counseling services?

Despite being an in-network provider with your client’s insurance, their plan may not cover for nutrition counseling services. Plan coverage varies widely, so it’s best that your client speaks with a representative to confirm coverage. For even more information, you may want to consider providing clients with the CPT codes you typically bill for. For example, CPT codes most commonly used by dietitians include: 97802 and 97803.

2. Is this wellness provider within network for me?

Your client will want to verify that you are an in-network provider. Choosing an in-network provider will likely give your client the best coverage. Insurance coverage also vary depending on the provider credentials — so be sure to clearly disclose your professional title and credentials. In general, registered dietitians tend to receive the most coverage in comparison to health coaches and nutritionists.

3. Is my diagnosis covered? Are preventive services covered?

For some insurance payers, only specific diagnoses may be covered for nutrition counseling services. For example, Medicare will only reimburse with a diagnosis of Diabetes, End Stage Renal Disease and/or a Kidney transplant within the past 6 months. Also, some insurance providers do not cover diagnosis codes for eating disorders.

If you typically bill insurance utilizing a preventive diagnosis (ie. ICD 10 code Z71.3) then you may want to provide this diagnosis code along with the proper CPT codes to your client. When clients verify their benefits, they can inquire about preventive services such as screenings or nutrition counseling for obesity. These services may be covered at 100% by their insurance provider.

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4. Do I have a copay and/or a deductible amount?

It’s important for clients to understand what their “client-owed responsibilities” will amount to. It can be upsetting for clients to be told that they are covered for nutrition counseling services, and then receive a bill in the mail for copays or deductible amounts.

When verifying benefits with their insurance representative, clients should directly ask if they have a copay, and if so, what is the amount.

In the case of deductibles, your client may need to pay out-of-pocket for services until they have met their deductible amount for the year. Have clients ask if they have a deductible, and if so, what their remaining amount is for the year.

5. Do I need a referral? If so, who can provide one?

Depending on the insurance payer, clients may or may-not require a referral letter. This is typically obtained from your client’s medical doctor to justify services such as medical nutrition therapy. If a client does require a referral, they can reach out to their doctor prior to their initial consultation to obtain one — and should ensure that it is provided to you (their wellness provider) in a timely manner so that you can promptly submit an insurance claim.

6. How many hours or nutrition counseling sessions do I qualify for?

Verifying insurance benefits for nutrition counseling services is the first step. Next, your client will want to ascertain the amount of coverage that they qualify for. Insurance providers may vary in how they provide this information, for example, Medicare states that a client is covered for 3 hours of nutritional counseling in their first year of seeking services, and only 2 hours of nutrition counseling in subsequent years. Other insurance providers may indicate that a client is covered for 3 nutrition counseling sessions each benefit year.

It’s important that your client asks for the specific benefit terms to fully understand the extent of it.

7. Am I covered for telehealth services?

If you offer virtual sessions (phone and/or video chat), then it’s important to verify if your client’s insurance plan covers for telehealth services. For many insurance providers, only in-person consultations are covered, or there are stipulations (ie. the initial consultation must be in-person, or a specific telehealth platform must be used). If your client is not covered for telehealth services, then they can expect to pay out-of-pocket for virtual services.

8. Am I covered for out-of-network benefits for nutrition counseling services?

If you are not a participating provider in your client’s insurance plan (ie. you do not accept insurance, or you don’t accept that particular insurance), your client may be covered with out-of-network benefits. In this case, your client can verify what percentage your services may be covered for (ie. your client may be covered at 80% for out-of-network providers).

If out-of-network, you may want to provide your client with a Superbill. A Super bill is essentially an itemized receipt of the services you have provided your client, which insurance payers recognize. If your client can expect to receive a superbill, they can verify with their insurance provider where they can submit their claim, as claims offices policies will vary by company.

Creating a superbill through Healthie

The Healthie platform supports nutrition and wellness professionals in:

• Generating a Superbill
• Sending a Superbill directly to a client
• Tracking the status of the Superbill

Superbills can be generated through the Healthie charting platform by navigating to the client’s chart. Select the chart note you’re generating the claim for (remember, claims can be submitted for multiple services, but the date of service needs to be listed for EACH session). Once selected, you’ll view a button on the top right of your screen “Create a Superbill.”

From here, the platform will automatically pre-fill the Superbill form with client and provider information. You can then edit the form directly, and add the relevant diagnosis code. For your convenience, there is a dropdown listing commonly used codes.

Learn more on how you can create Superbills and/or manage your insurance billing through Healthie. Start your free trial today.