Insurance Coverage for Dietary Counseling

Are you interested in taking health 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.

What nutrition services are covered by health insurance?

Coverage today still very much depends on an individual’s health 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.

When determining which insurance companies to become in-network with, it’s best to do some market research. Learn which insurance plans the major medical facilities, hospitals and nearby medical offices accept. Research which plans other dietitians in your area are in-network with. The larger insurance providers in your area will provide you with the most client referrals.

What are the benefits of accepting health insurance in nutrition practice?

For dietitians, accepting insurance in private practice can expand your client base and drive referrals. Many clients are seeking ways to access affordable nutritional care, and accepting insurance allows clients to save on their healthcare costs. Although there is a learning curve initially in understanding insurance billing and coding, many dietitians in private practice can confidently manage their own billing.

How to Get Started with Accepting Health Insurance

After you make your list of insurance companies that you’d like to credential with in your area, it’s best to reach out to each company and ask if they are accepting new providers for your locale. The network may currently be saturated, and no no applicants are permitted. Otherwise, you’ll be directed to fill out an application to become an in-network provider. Each insurance company will have their own unique application, but all providers will need access to review your CAQH profile. CAQH ProView is a credentialing database that allows insurance companies to view and verify your professional and practice information for claims administration, credentialing, directory services, and more.

The insurance credentialing process can take several months, from 3-9 months to become a credentialed in-network provider. In the meantime, you can still counsel clients at self-pay rates as well as put the proper systems in place to begin insurance billing. With insurance billing platforms that integrate with EHR, dietitians can seamlessly chart on clients and create CMS 1500 claims in minutes. This saves times and ensures more accurate claims, improving approval for submitting claims.

Learn how Healthie can help provide the tools you need to run an insurance-based nutrition practice.

5 Responses

  1. Is nutrition counseling via skype or tele health covered in NJ under Aetna and most insurance plans?

    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! 🙂

  2. When did Medicare start covering MNT for obesity? Used to be 3 hours per year only for diabetes or kidney disease. Thanks!

  3. I would like to sell packages to my clients where they pay up front for multiple sessions (accountability), but can I do that if I am in network with insurance?

    1. You may not be able to do that with an insurance-based practice, however, you can do this if you’re private pay, or then offer your clients a Superbill for their services. Hope this helps!

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