PCOS, Insurance, Nutrition

Did you know that your health insurance will likely cover the majority of the cost of nutritional counseling for PCOS?

It will only take a couple of minutes for you to call and verify your health insurance for PCOS medical nutrition therapy. 

Read the information below to learn the steps to take to see if your insurance will cover the cost of nutrition counseling for PCOS.

What insurance companies does Amy and her team at The Plano Program participate with?

At the present time, Amy and her team are in-network providers with Medicare, Aetna, Cigna, Connecticare, Emblem, Harvard Pilgrim Health Care,  Anthem Blue Cross and Blue Shield, and United Health Care.

I live far away, can I use my health insurance for PCOS nutritional counseling for telehealth with Amy's team?

Yes. Your health insurance can be used for BOTH virtual and face-face visits with Amy’s team. (whoot whoot!)  We do follow licensure rules for dietitians. So it may be possible based on your location at the time of the telehealth visit we might be able to work with you. But we would let you know that in advance and recommend a local RD who could provide the service.

What happens if Amy's team doesn't participate with my insurance?

We participate with ALL of the major commercial insurance companies. We are happy to set you up with the appropriate paperwork for you to submit to them directly for reimbursement if you have insurance we don’t participate with. However, often this is not necessary as our team is with all the major insurance carriers.

We don’t accept Medicaid or Husky at this time. It is not that we don’t want to. They just don’t cover any nutrition services in a private practice setting. 

Is there a charge for the various programs you offer even if I have unlimited visits covered by insurance carrier?

Yes, there is a start-up fee of $375.00 plus tax which includes your initial assessment, Bodygem Metabolism Test, and your customized meal planner booklet. Amy and her team can provide more concrete details of the cost once she knows what you have for coverage through your insurance carrier. Please feel free to email her office staff at amy.plano@yahoo.com with specific insurance-related questions. Let us know what state you are in and who your health insurance is through. We will get back to you within 24 with more information.

What If I only have 2 covered visits, am I still eligible for the nutrition program?
Yes, these visits will get deducted from the total price of the program.
What questions should I ask when calling my insurance company? You should ask your insurance company all of the following questions:

Please note it is the patient’s responsibility to call their insurance company PRIOR to your visit to confirm coverage. I know we sound like a broken record – we just don’t want our patients to have ANY surprise bills. 

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 (aka 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 of your plan. 
  • If you are overweight, obese, or 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. 

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?

  • 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 if often NO cost share for you associated with the visit. Once again, this is something YOU do want to ask prior to your visit. 
  • In the event 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 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. 

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 in my particular 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?

If you have any questions after verifying your benefits we are happy to help. Please email Michele Ramos @ mrs.micheleramos@gmail.com. She will return your message within 48 business hours. 

Still have insurance questions? No problemo!
Anthem BlueCross BlueSheild
Harvard pilgrim Health Care