What is Covered? Navigating Insurance Coverage for Dietetic Private Practices

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Are you interested in taking insurance at your private practice? The good news is that more and more insurance companies are beginning to cover nutritional therapy, dietetic, and behavioral therapy programs as a care solution for pre-diabetic individuals and as a weight-loss solution. Since the Affordable Care Act was enacted in 2010 and obesity became a medically recognized disease, 33 states have begun to require full or partial coverage for bariatric surgery and/or nutritional counseling and this trend is only expected to further develop as nutritional therapy, weight loss counseling, and behavioral therapy prove to be an effective treatment.

So, what is covered exactly?

Coverage today still very much depends on an individual’s insurance plan and what preexisting conditions may qualify him or her for coverage.  Most generally, obesity requires a form of weight-loss treatment, whether that be through bariatric surgery or through counseling. As it stands, obesity is defined as having a Body Mass Index (BMI) of 30 or higher. Many insurance plans also cover nutritional therapy for diabetic or pre-diabetic clients regardless of BMI.

On Medicare, obesity screening and counseling is available for all people with a BMI of or over 30 with the number of counseling sessions determined by the individual’s primary care doctor or practitioner.

Aetna, however, limits individual and/or group counseling sessions to 26 over a 12-month period for the same qualifying individuals with a BMI of 30 or higher. With Aetna’s plan, there is also a list of services considered medically necessary for the evaluation of overweight and obese individuals. When criteria is met from these evaluations, counseling or even bariatric surgery are considered necessary.

Cigna covers nutritional counseling but to what extent and how many sessions that covers varies much by plan. Luckily, most plans do cover the full cost of counseling sessions.

One of the most exciting aspects of this development is in its exclusivity. While some insurance companies are beginning to cover Weight Watchers and Jenny Craig, most do not and trust more in the expertise of trained professionals such as dietitians and nutritionists. There is a new understanding emerging that diets just don’t work. Diets are a short-term solution that will hurt the insurance companies more than help them.

3 Responses

    1. Great question! Thanks for asking! It varies a lot by insurance company, but companies such as Horizon BCBS NJ will generally state that they cover nutritional counseling programs for qualifying individuals. Many insurance companies will specify necessarily licensing or degrees required for the provider (which again will vary greatly by company) but not necessarily what type of session. For example, in Aetna’s policy, Aetna will cover 26 total sessions whether they be individual sessions or group sessions. Telehealth-only private practices can be credentialed by insurance companies and often are. What kind of coverage your clients receive will still very much vary by company. I hope this helps a little! 🙂

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