Do you hate letting things go to waste? You may be more aware of that lettuce in the back of your fridge than you are of your health insurance benefits! For example, do you know if your health insurance will cover nutritionists? Do you know when you can see a nutritionist or for how many sessions?
I’m going to teach you how you can find out if you have nutrition insurance coverage today!
Pull out your health insurance card and a notepad to get started.
Health Insurance 101
Health insurance payers
Private pay insurance is any insurance company that is not federally run. The most common examples of private pay insurance in the United States are;
Private pay insurance is usually provided through employers, marketplace plans, or health insurance agents.
Medicare is a federal health insurance plan. Insurance coverage for those over the age of 65, certain disabilities, and those with end stage kidney failure on dialysis. If you are under 65 years old but are on dialysis, you qualify for Medicare health insurance.
Some people are automatically enrolled into Medicare once they turn 65. Many are required to apply for Medicare coverage once they qualify. This is most often the case for those on dialysis – you can speak with your dialysis social worker to help enroll.
Medicare covers 80% of dialysis costs. It is highly recommended those on dialysis have two health insurance plans to cover the remaining costs. You must have Medicare Part B to get outpatient (in a normal dialysis clinic) or home dialysis.
Many people on dialysis also choose to have Part D included, which covers many prescription drugs. (The average number of medications a person on dialysis takes is 19 pills per day.)
Medicare advantage plans are provided by private payer companies. While they are provided by private companies, they follow the Medicare guidelines for coverage.
Medicaid is a state-run health insurance program offered to low-income individuals. The Children’s Health Insurance Program (CHIP) falls under Medicaid and offers health insurance for children under the age of 18.
Those on dialysis may also qualify for Medicaid plans in their state. Again, it’s best to speak with your social worker in the dialysis center to determine what insurance coverage you qualify for.
Tricare is the health care program for uniformed service members, their families, and retirees from service. It provides health coverage similar to private pay or Medicare plans and covers medical treatments and prescriptions. There are several types of plans within Tricare for eligible members to choose from.
Health Insurance Plans
Health Maintenance Organization
A health maintenance organization (HMO) is one of the most common plans. It does not provide as much flexibility as a PPO.
With a HMO, you’ll want to be sure you have updated provider directory information to know exactly which providers you can see with your health insurance. Be prepared to pay the full bill f you choose to see a provider that does not take your insurance.
Preferred Provider Organization
A preferred provider organization (PPO) plan allows more ability to see providers outside of your plan. You may need to pay a certain amount of the bill if you choose to see a doctor out of the health insurance network.
With a PPO, you generally won’t need a referral from your primary care physician. However, you may pay more out of pocket.
Point of Service
With a point of service (POS) plan, you must have a referral from your primary doctor. Even so, you’re still likely to have access to a greater variety of providers compared to an HMO plan.
Exclusive Provider Organization
An Exclusive Provider Organization (EPO) is a health plan that includes a local provider directory. Expect to pay out of pocket if you want to see a provider that is not included in your provider directory. Emergencies are excluded in this.
An EPO plan generally has a premium and higher deductible.
High Deductible Health Plan
A High Deductible Health Plan (HDHP) is a health insurance plan that requires a larger deductible to be paid before insurance coverage starts. As of 2021, the IRS define a HDHP as a plan with an annual deductible that is at least $1,400 for self-only coverage or $2,800 for family coverage.
The annual out-of-pocket expenses – including deductibles, co-payments, and other amounts, but not premiums – do not exceed $7,000 for self-only coverage or $14,000 for family coverage.
Health Insurance Key Terms
The premium is what you pay to have an active health insurance plan. This payment can be monthly, quarterly, or annually.
If you receive health insurance through your employer, they may pay some or all of this piece of your health insurance premium. You can find details on your paystub or by speaking with your human resources department.
Your deductible is the amount you will pay before your health insurance “kicks in” to cover the rest. The deductible can be a few hundred to several thousand depending on your health insurance plan. Once you have spent the deductible amount, you’ll only be responsible for the copay.
For example, if you have a deductible of $1,500, you’ll be paying for certain aspects of your care until the total spent is $1500 before your health insurance comes in to cover costs. Many plans, though, will cover health expenses like preventive visits before you run through your deductible.
In general, plans with lower premiums will have higher deductibles. It’s up to you to decide on if you want to spend the money ahead with a plan that will cover more later, or spend less now and pay more at the doctor’s office.
Copay or copayment
The copay is your amount due at a service after you have paid your deductible. Copays can vary depending on the type of service provided. For example, your primary doctor may have a lower copay than a specialist will. The copay is a fixed amount you can often find listed on your health insurance card.
Copays are required regardless of how much you have put towards your deductible. In many cases, your copay can be counted towards your deductible.
Similar to the deductible, plans with lower premiums may have higher copays.
Co-insurance is the amount you will pay after meeting your deductible. It’s essentially the part of the medical expense that you are responsible for.
For example, your plan may have an 80/20 coinsurance plan, in which your health insurance payer covers 80% of the bill and you pay 20% of the bill. This is different from your co-pay as it is a percentage of the expense rather than a fixed amount.
Also called the out-of-pocket maximum, this is the most you will pay towards your costs. This includes your deductible, copays and co-insurance.
This is the maximum amount a health insurance plan will pay for a covered health care service. If your provider charges more than this amount, you may have to pay the difference.
Health Savings Account
A health savings account (HSA) is a type of savings account that lets you set aside pre-tax income to a savings account used to pay medical expenses. They are offered in High Deductible Health Plans. You can also find HSAs through banks.
Health Savings Accounts can be an extremely valuable asset as it saves on taxes. For example, your HSA can be used towards health expenses including copays, deductibles, and even purchases like contact lenses or health programs (like the Plant-Powered Kidneys course!).
HSAs cannot be used towards your health insurance premiums.
You can contribute towards your HSA every year. For 2021, a self-only plan will allow up to $3,600. For a person with family coverage, you may contribute up to $7,200 for the year. If you are over the age of 55, you can contribute an additional $1,000 per year.
Flexible Savings Account
A flexible savings account is similar to an HSA in some ways. A FSA is through your employer and still allows you to use pre-tax dollars towards out-of-pocket expenses. With a FSA, though, you must use all funds before the plan year ends.
A superbill is a receipt of a medical service provided if or when you pay out-of-pocket. It will include the codes needed for your health insurance company. It will be up to the insurance company to determine any reimbursement.
Superbills will be provided after the rendered service. If you are seeing a specialist, such as a dietitian, your health insurance may require you to obtain details from your primary physician. This is similar to getting a referral.
What’s the difference between a dietitian and a nutritionist?
The two terms are very often used interchangeably. However, there is a big difference between a registered dietitian and a nutritionist.
The path to becoming a registered dietitian
A registered dietitian is a credentialed healthcare professional. To become a registered dietitian, a person must go through college to obtain a bachelor’s degree by a US regionally accredited college (or foreign equivalent). In 2024, it will be mandatory to complete a master’s degree to qualify as a registered dietitian.
Next, the person must be accepted into a nationally recognized dietetic internship program. The internship is a highly competitive area to get into, with about a 50% admittance rate. The internship will provide 1,200 hours of supervised – and most often unpaid – experience with several different nutrition fields.
Upon completion of the internship, the person will qualify to sit for the national dietitian exam. Passing the exam then earns them the title of “registered dietitian.”
The path to becoming a nutritionist
The term nutritionist is an unregulated term. There is no board or governing body that regulates the term.
Anyone can call themselves a nutritionist. You can call yourself a nutritionist if you wanted. (I’m not encouraging this – it’s merely to prove the point that it doesn’t mean much.)
There are certain licensures for nutritionists where a person can use certain credentials. You can read more about the different terms related to nutritionists here.
How can I find out if my insurance covers dietitian nutritionists?
Now that you know some of the plans and “jargon” of health insurance, we can ask the question, does my insurance cover nutritionists?
Find out if your health insurance plan includes nutrition insurance coverage, or medical nutrition therapy.
Contact your health insurance provider
Call the 800- number on the back of your health insurance card and speak with a representative. Be sure you write down their name. Have them spell it for you several times if needed.
For one, it will be helpful to know who you’re speaking to, and another reason is you’ll be able to identify with whom you spoke if you need to challenge a bill.
Determine your covered nutrition services
This is the time to ask if your insurance covers nutritionists. Ask the representative, “are nutritionists covered by my insurance?”
Ask if you have nutrition counseling services or nutrition insurance coverage. The common procedure technology (CPT) codes for services are 97802 and 97803.
As an alternative, ask about any coverage for medical nutrition therapy.
Find your ICD-10 codes
Your benefits may require certain diagnoses. These will come from your International Classification of Diseases (ICD) codes and there are more than 70,000 disease codes available.
The next thing you’ll want to do is find out if there are any specific diagnosis required by your insurance company. You can ask about preventive nutrition, which uses ICD-10 code Z71.3.
It’s important to know that only your physician can diagnose you with these codes (with the exception of Z71.3 as it is preventive care). You can find your ICD-10 codes in your online health chart or by calling your doctor’s office.
Write down any requirements the representative informs you of.
Find out how many visits you have per year with a dietitian nutritionist.
It could be anywhere from zero to unlimited. That being said, this may also hinge on the ICD-10 codes you have.
Equally important, ask when the start of the year is for benefits. Be sure to ask what the start and end dates are for your annual plan. Benefits can reset for the “new year.”
Have I met my deductible?
Find out if you do, and how much. If you need to reach a deductible, you can request a superbill from your provider/specialist. This is basically a receipt that you can send to your health insurance provider that will go towards your deductible. Once you meet your deductible, you may have 100% coverage.
What is my copay?
Ask about any copay required to see a registered dietitian. Health insurance covers dietitian nutritionists under specialists. This information may be on your insurance card – check for specialist copay.
Do I have out of network benefits?
If yes, you can look at dietitian nutritionists and other healthcare providers that are outside of your health insurance network. If no, ask where you can get a list of dietitians that are in-network for you. (This is how you may be able to work with me and have insurance help cover some of the investment.)
Does my insurance cover telehealth visits?
Sometimes they will know this immediately and sometimes they won’t. You may be able to ask about location code 02 or modifier code GT.
In the past year, many insurances have opened up more opportunities for people to see their healthcare providers via telehealth visits. Medicare currently accepts telehealth as a way for you to see your providers.
So call now and start using the benefits that you (or your employer) are paying for! Keep yourself healthy and surround yourself with a team that wants the best for you and are willing to do what they can to get you to the goals you want to achieve.
Are nutritionists covered by Medicare?
Medicare allows for three hours of medical nutrition therapy with a registered dietitian and two hours every year after. You may be able to qualify for additional hours if your doctor says you need them.
Medicare nutrition coverage for dialysis
If you are on dialysis in the United States, your insurance covers your dietitian visits at your dialysis clinic. Dialysis dietitians are very busy and must see many patients, so be sure to communicate with your dietitian when you have a question! We love when our patients want to see us!
How to find a dietitian nutritionist that takes your health insurance
The Academy of Nutrition and Dietetics offers a search feature for you to look up dietitians right in your area. Simply type in your zip code and look through the profiles that appear! Many will list the types of insurance they provide
National Kidney Foundation’s Dietitian Directory
The National Kidney Foundation has created a directory of dietitians in the United States that help people with chronic kidney disease. You’ll find me there!
The listings include insurances accepted, but be sure to reach out and verify that the information is up to date.
International Dietitian Directories
If you are outside of the United States, you may be able to find a dietitian in your country by searching your country + dietitian. I have compiled a list of dietitian websites in different countries here.
Your health insurance company
You can use their provider directory to look up dietitians that are in your network. As a personal note, don’t consider this the comprehensive list of dietitians available in your network. It can be a real pain for us to get on there!
Ask your fave dietitian
If you find a dietitian that you would like to work with, be sure to check out their website or call them up. They’ll be able to let you know what types of insurance they take and any other available payment methods.
I do not take insurance at this time, but I do accept HSA and FSAs.
You likely pay a good amount to have health insurance, so why not find out if your health insurance covers nutritionists? Once you know what coverage you have, you’ll be on your way to your own personalized renal diet with your own registered dietitian.