Insurance Coverage
This page is dedicated to helping you understand how insurance can and can’t be used to get your nutrition services covered!
The Basics
Many insurance companies cover services delivered by a Registered Dietitian in full, but there are a few nuances.
Each plan is different, so it’s important to understand your unique plan. This is based on my experience as a dietitian billing private insurance companies, so your mileage may vary if you have a state plan or Medicare/Medicaid.
Simply put, there are two ways that insurance can pay for nutrition services: In-Network or Out-of-Network benefits.
When your dietitian is “in-network” with an insurance company, it means that they have a contract with the company and will submit claims for services directly to the insurance company. If they do not have a contract, they are considered “Out-Of-Network” (OON). In this case, you pay the dietitian directly and then you can submit a superbill (a super-charged receipt) to your insurance company and services may be partially reimbursed or the amount will be applied towards your deductible.
If your plan covers nutrition services, it may cover it as part of preventative benefits or as part of your medical benefits.
Preventative benefits are typically exempt from a deductible, meaning that even if you have a deductible, your insurance company will cover the cost.
Medical benefits often will apply towards your deductible, meaning that if your plan has a deductible, you will be paying out of pocket for services that will be billed to you by your dietitian.
Medical Benefits vs. Preventative Benefits
Insurance companies will have very specific requirements for what is considered preventative care versus medical care.
Aetna, for example, uses the United States Task Force on Preventative Medicine levels A and B of evidence to determine what is covered, and “for individuals with cardiovascular disease risk factors behavioral counseling interventions to promote a healthy diet and physical activity.”
These factors, including diabetes, BMI >25, high cholesterol, hypertension, family history of sudden cardiac death, family history of ischemic heart disease and other diseases of the circulatory system, family history of diabetes mellitus (family history is considered first degree relative, a parent or a sibling), must be documented in your medical chart to ensure that policy guidelines are being met and to reduce the likelihood that the claim will be denied and that you will be responsible for footing the bill.
Medical benefits require that “medical necessity” is being met for nutrition counseling.
This means that nutrition is considered an appropriate part of treatment for a given diagnosis. For example, nutrition is an evidence-based treatment component of managing diabetes. Even though ADHD can significantly impact someone’s nutrition status, it’s not considered a covered diagnosis for nutrition counseling.
Some insurance companies can be more limited in what diagnoses are covered, so it’s important to check if there are limitations. Medicare Part A and Medicaid, for example, only covers diagnoses of chronic kidney disease and diabetes. Personally, I have opted not to enter a contract with either because most of my clients seeking nutrition care do not have those conditions.
Limitations
Insurance only covers face-to-face time that happens during sessions, so if there are “extras” that are considered “non-covered” services, you would have to pay out of pocket for this.
In my work, this can look like: written consultation reports, additional or extensive care coordination, or specific fueling plans and additional support between sessions.
I always want to be honest and transparent with what is covered, and unfortunately at times the information that a representative gives over the phone is inaccurate, or you may get conflicting information.
My practice has shifted where it is the responsibility of the client to obtain insurance benefits because of this. Sometimes, it’s only once I have billed the claim that I learn that the individual has a copay or the service will go to their deductible.
I have a guide to check benefits below that you can download to check your benefits and coverage with Brick by Brick Sports Nutrition.
I am currently in-network with commercial plans from Independent Health, Highmark BCBS and Blue Cross Blue Shield PPO plans, Aetna, United Health, and Univera. Most insurance companies also have the ability to search for a provider, so if you’re not sure if I’m in your plan’s network, you can check there.