Insurance & Rates

Insurance Coverage for Nutrition Counseling & Medical Nutrition Therapy:

95% of our patients are fully covered for telehealth nutrition services through in-network insurance plans with no copay, no out-of-pocket costs, and no deductible needed— It is at no extra cost to you!

Claims

Wholesome Nutrition accepts BlueCross BlueShield, UnitedHealthcare, and UnitedMedicalResources. If you are using insurance, claims will be submitted directly to your insurance company after each session. Although 95% of our patients have full coverage, it is recommended to verify your insurance benefits before your first session, as your specific policy could also have limitations and exceptions. Coverage details are for primary insurance providers.

Session Rates & Self-Pay

For self-pay patients, our sessions are $125 each. We accept credit and debit cards, as well as HSA/FSA cards. A card on file is required to secure all appointments. In the rare event insurance denies claims, appointments that have been completed will follow the same session rate of $125 each.

Denials & Limitations

The following information is based on our experience with billing for these insurance companies and is intended to provide guidance, not certainty: In our personal experience, labor union plans, self-funded plans, EPO plans, and some out-of-state plans can limit preventative nutrition services. These limitations usually require a specific diagnosis to gain coverage. Some of these unique plans exclude preventative benefits altogether. EPO (Exclusive Provider Organization) plans dictate which providers you can see to have services covered. If your plan requires a specific diagnosis code, a referral from your primary care provider may be needed to document eligibility before your first session. Although these instances are a rarity, Wholesome Nutrition does its best to supply you with the necessary information to verify your benefits with your insurance company. It is in your best interest to contact your insurance carrier to understand your coverage. Additionally, Wholesome Nutrition will work diligently to dispute any denied claims and advocate for your insurance coverage. In the event that coverage is not met, or a co-pay is needed, you will be notified, invoiced, and charged to the payment method on file. Our self-pay session rates are $125 per appointment.

Out-of-Network & Superbills

If your plan is out-of-network, we can provide a monthly superbill for you to submit to your insurance company. Reimbursement is not guaranteed, and you remain responsible for payment regardless of insurance reimbursement. We strongly recommend contacting your insurance provider before scheduling to understand your out-of-network benefits and any potential financial responsibility.

Determine Your Insurance Plan Coverage Details

Utilize this script of questions when calling your insurance representative: 1. Do I have coverage for preventative nutrition counseling / Medical Nutrition Therapy (MNT)? Ask if these CPT codes are covered: 97802 (initial) and 97803 (follow-ups) If not covered, ask them to check: 99401 – 99404 2. What diagnosis codes are covered for nutrition visits? Ask if ICD-10 Z71.3 (nutrition counseling) is covered. If not, ask which diagnoses are covered (examples: diabetes, obesity, high blood pressure, cardiovascular conditions). If a specific medical diagnosis is required, we may need a doctor referral with the applicable ICD-10 code. You can request a referral from your doctor and have it faxed to us at 815-277-1279. 3. Is telehealth nutrition counseling covered? Confirm coverage for virtual/video visits. 4. How many visits are covered per year? Ask if there is a visit limit or unit limit per calendar year. 5. Do I need to meet a deductible first? Ask if nutrition counseling is covered before the deductible is met, or if you pay out-of-pocket until it’s met (unlikely). 6. What will my cost be? Ask about a copay or coinsurance. 7. Can I get a reference number for this call? Always request a reference ID for your conversation.

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Insurance & Rates

Insurance Coverage for Nutrition Counseling & Medical Nutrition Therapy:

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