of Does Does Insurance Cover Nutrition Counseling?

Does insurance have you stumped? Read on to learn the in’s and out’s of navigating insurance! 

Insurance. It can be a jungle! I understand if it’s confusing and frustrating.  Here we’ve set out to help demystify the lingo, clarify what we usually see when billing for nutrition counseling, and hopefully make the path a bit easier for you.  In this article, we cover each of the insurances we often work with.  We also discuss some insurance FAQs and there’s a glossary of insurance terms. 

Do you bill insurance?

Yes, each of us has a different list of what insurance we do or don’t take. 

 

Do you check benefits for clients? 

No, we ask you to check.  Here’s our guide for calling insurance.  

 

Read on to learn more about nutrition coverage by your insurance company!

person holding black smartphone

 

 

Anthem

Anthem Inc. Logo

Makena takes Anthem and Lynae will soon.  Anthem is under the bigger umbrella of Blue Cross/Blue Shield (BCBS).  Each insurance plan is different, although they often cover nutrition. Sometimes it’s only 3 visits or just 6 visits, sometimes it’s unlimited.  Once in a while they don’t cover nutrition.  

Be sure to check your plan before you get started. 

 

 

Blue Cross/Blue Shield

Blue Cross and Blue Shield

Makena takes Blue Cross Blue Shield and Lynae will soon. In Oregon this is often called Regence, although it’s a bigger umbrella that includes other names.  Plans from other states can be used in Oregon, no problem.  Each plan is different: sometimes they only cover 3 appointments per year, sometimes it’s not covered and often it’s covered without limits .  Be sure to check your plan before you get started. 

 

 

Cigna

Cigna logo vector

Lynae and Makena take Cigna. Cigna is pretty limited in what they cover for nutrition. They sometimes have a limit on the number of visits, for example three per plan year. However, some diagnoses also have unlimited nutrition visits. Be sure to check your plan before you get started. 

 

First Choice

First Choice Health

Lynae and Makena take First Choice.  Be sure to check your plan before you get started. 

 

Regence

Regence BlueCross BlueShield of Oregon and Utah, Regence BlueShield of Idaho and select counties of Washington

Makena takes Regence and Lynae will be soon. Regence is under the bigger umbrella of Blue Cross/Blue Shield (BCBS).  Each plan is different, although they often cover nutrition. Be sure to check your plan before you get started. 

 

Moda

Moda Health

Makena takes Moda.  This insurance will bill nutrition appointments as part of your mental health benefit if you’re getting support for an eating disorder. If you’re getting support for something else, such as diabetes they bill it under your medical benefits.  Often a preauthorization is required and we’ll need a referral from your doctor’s office.  Be sure to check your plan before you get started. 

 

OHP / Medicaid / Care Oregon / PacificSource Community Solutions

Oregon Health Plan logo                               PacificSource Community Solutions Logo

Makena takes OHP.

Often they cover nutrition.  This is under a bigger umbrella of Medicaid.  In Lane County (Eugene/Springfield area) there are 2 types of OHP, and this is one of them.  In Deschutes County (Bend area), this is the OHP that’s available. In the Portland Metro area, often it’s Care Oregon.  Be sure to get a doctor’s referral faxed over to us. Be sure to call to check your benefits before you get started. 

 

PacificSource

PacificSource Health Plans

Makena and Lynae take Pacific Source Commercial. There are two versions of Pacific Source in Oregon.  One is part of OHP and the other is “commercial”.   If you get your insurance through the marketplace or through your employer, it’s likely going to be the commercial version of Pacfic Source.  

They often cover anorexia, bulimia and sometimes diabetes.  Some plans don’t cover nutrition.  Once in a while a client has a plan that covers preventative health.  It’s always worth a shot to call and ask. 

 

Providence

Providence

Lynae and Makena take Providence.  Providence will often cover nutrition appointments, although not always.  Be sure to ask if you have preventative health coverage. 

Be sure to check your plan before you get started. 

 

 

I don’t see my insurance listed. What does this mean?

If your insurance isn’t on the list, we don’t take it unfortunately.   Each of us has self-pay options.  Check Lynae or Makena for rates. 

 

What if I have financial concerns? 

Lynae and Makena offer options based on financial need.  We do not offer sliding-scale, but we offer scholarship options.

 

You’re listed by my insurance, so appointments are covered, right? 

Not necessarily.  Each person’s insurance plan will have a section for nutrition benefits…or not.  Some plans don’t cover nutrition at all, but many do.  

 

For example: I looked up my dietitian through my Providence and it says you’re in-network, so that means it’s covered, right?  With Providence we often see that they will cover nutrition, but not always. Be sure to check your individual insurance coverage. 

 

How does it work if I have a deductible?

This one is a little more complicated.  Each person’s plan has a different deductible, so first find out what yours is.  Let’s say for instance Dave has a deductible of $500 for the year and he found out nutrition is covered, but only after his deductible is paid off.  This is called “subject to deductible”.  Dave will have to pay the full cost of each appointment until he meets that $500 amount, and then insurance will start covering a portion of the cost of appointments.  He might meet it faster if he’s also paying toward his deductible for other appointments such as a doctor’s appointments that are also subject to deductible.  Or, if it’s later in the year he may already have it paid off!  

 

Feel free to ask questions about how this works. 

 

Do you bill secondary insurance if primary insurance doesn’t cover?

No.  If you’d like to pay and then submit it to your secondary insurance we can give you something called a superbill to send in to your insurance.  

 

Can I use my HSA or FSA card?

Yes! Absolutely.

 

Glossary:

 

Copay

The cost the client is responsible for.  Often this is a set number such as $30 or $80 per appointment.  This varies considerably depending on what insurance and what plan. For example, Providence doesn’t often charge clients a copay, but Cigna usually does.

 

Coinsurance:

This is like a copay except it’s usually a percentage of the cost billed.  For example if you have 20% coinsurance on a nutrition visit then insurance pays 80% of the allowed amount and you pay the remaining 20%.

 

Example: Your nutritionist might bill $240 for a visit. Then insurance might decide they’ll cover $130. This is called the “allowed amount”.   If they cover 80% of the $130, then they paid the nutritionist $104 and you pay the remaining $26. 

 

In-Network:  

This means your dietitian nutritionist has a contract with your insurance company but we still won’t know if your specific plan has a nutrition benefit.  Be sure to call and find out more. 

 

Nutrition Counseling: 

This is usually the label used by insurance companies for the services provided by a registered dietitian nutritionist.  Although the word “counseling” is in there, it’s considered a medical benefit, not mental health.

 

Nutrition Therapy:

Sometimes insurance labels nutrition under “medical nutrition therapy”.  This is considered medical care for a specific diagnosis such as diabetes, it’s not billed the same as mental health therapy. 

 

Out-of-network

This means your nutritionist doesn’t take your insurance. For example, maybe you have Kaiser insurance. None of our nutritionists take Kaiser, so we are out-of-network. Some insurance plans will cover “out-of-network” providers so call them to find out more.  

 

Secondary Insurance

This is an additional insurance. For example, you may have Regence insurance through your employer and your spouse may have Providence. If you are covered on both plans, then one of them is called “primary insurance” and the other is your “secondary” insurance. If we bill insurance it would be your primary insurance. If you choose to submit to your secondary insurance we can provide you with a superbill for the balance due. 

 

Superbill

A statement of payment. It’s a medical receipt. It usually includes medical billing codes such as a CPT code, diagnosis code, NPI and other details so that an insurance company can see what the bill was for. 

 

 

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Questions about your first visit? FAQ
What can I expect on the first visit?

We’ll talk about what you want to work toward with your health and food goals.  We’ll explore your health history, relationship with certain foods, what foods you like and don’t like and what nutrition goals will work best for you. We’ll develop a wellness vision and get you started on that path.

“I did not know what a dietitian did or what to expect. I thought I would get a meal plan but this was not necessary for​ the work I did. In working with Natalie, I was able to get to the bottom of many of the myths I’ve been told about nutrition. It allowed me to challenge the list of rules I was placing on myself that lead to eliminating foods I once enjoyed. The permission to eat foods I enjoy helped decrease bingeing on them and targeted the shame cycle that was happening. Thank you.” -client SL

What is Health At Every Size (HAES)®

Health At Every Size (HAES)® is a weight-inclusive approach that respects body diversity, supports health from a holistic perspective (physical, psychological, emotional, social, relational, spiritual, etc), and works to end weight stigma & discrimination.

This movement recognizes that health is complex and that the pursuit of health is not a moral obligation, as well as the notion that health status should never be used to judge or oppress an individual. HAES® is rooted in a social justice framework and acknowledges the impact that shame, stigma, and oppression can have on health and well-being. The focus is shifted from weight control to supporting self-care practices that allow one to tap into their body’s inner wisdom. The HAES® principles include promoting flexible eating with respect to internal cues, and life-enhancing movement that supports physical activities for all sizes, abilities, and interests.

Read more about HAES® here:

Do you bill insurance?

Yes.  See the insurance page for more details.

Do you offer virtual appointments?

Yes! We offer virtual appointments via a secure, HIPAA-compliant video platform. 

What if I'm embarrassed about how I eat?

We strive to provide a safe and non-judgmental environment for you to explore your food concerns. We won’t be labeling foods “good” or “bad”. In fact, my clients frequently report significantly reduced shame around food after working together.

Are you LBGTQIAP+ friendly?

LGBTQ-flag; Everyone is welcome here

Absolutely, we enjoy working with people of all genders, any sexual orientation, religious or cultural background.  

Will you collaborate with other medical providers?

Yes, we prefer to collaborate with your other providers to ensure you get the highest quality of care. Those struggling with eating disorders need a “team” which hopefully includes, a dietitian, therapist, and primary care provider. If you need help finding the support we can offer local referrals.

Frequently Asked Questions

Are you nervous about your first visit?  No worries.  These questions might answer some of the concerns you might have.

Make an Appointment!

Are you ready to get started on your journey of freedom from diets? Would you like to make an appointment with one of our nutritionists or our therapist? Look through our team of providers and get started now!

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About Me

Lynae Smith is the owner and founder of Ruby Health and Wellness. Her crusade is to empower people to embrace who they are, free from diets. She encourages all to tap into their inner strength and not base your self-image on size.

Ruby Health and Wellness