North Carolina Registered Dietitian Nutritionist Group Insurance and Plans for Medical Nutrition Therapy
We are in network with Medicare, Tricare Select, United Healthcare, Cigna, Aetna, First Carolina Care, MedCost, Blue Cross Blue Shield of North Carolina, and Medicaid of NC . We can bill out of network to other payers and/or provide a superbill.
We believe:
- Up-to-date and expert functional medicine and dietitian services should be accessible for everyone.
- Good nutrition is the basis of health and wellness.
- Women’s nutrition is the cornerstone of family health.
- Prenatal nutrition and child nutrition services can lead to a lifetime of healthy living, improved education, and better body image.
- Through nutrition coaching, we can empower our patients to make the best lifestyle and diet choices to live lives of wellness.
Our Nutrition Counseling Services and Practice is in network with most major health insurance plans. Please note that not all plans have coverage for medical nutrition therapy, and coverage also may depend on what medical diagnoses you have. You can use THIS SCRIPT to call your insurance (use the number on your insurance card) to verify your nutrition benefits. Please write down what you find out so that you can share with us if you schedule an appointment.
For those who need medical nutrition therapy but are not covered, contact us for more information on our competitively priced private nutrition services and plans.
Cash Rates
Work with one of our Integrative and Functional Nutrition Certified Practitioners (IFNCP) or Registered Dietitian Nutritionists (RDN) to develop an achievable nutritional plan to treat your chronic condition, help you achieve your weight-management goals, and be an essential part of a life of wellness. We offer expert nutrition counseling at competitive rates.
Initial nutrition consultations are 75 minutes and cost $195. Follow-ups are 60 minutes and cost $125. We offer cash pay discount packages of $395 for set of 3 sessions (12% discount) or $315 for a set of 3 follow-ups (16% discount).
We also offer a 10% military discount (can combine with above discounted packages).
We accept payment by flex spending accounts (i.e. HSA, FSA) and all major credit cards. We can also provide super bills after appointments, for reimbursement requests to your insurance company.
Insurance Details By Plan
Below is a guide for each insurance plan. This is not a guarantee of coverage, as every insurance plan is different. Some plans are grandfathered, self-insured and decide which codes they will cover. * If your plan requires a referral form be sent to us, please ensure your referrals include all ICD-10 codes applicable to your treatments. We CANNOT submit claims if ICD-10 codes are left off of referrals.
– There are many different Anthem Blue Cross Blue Shield plans and individual BCBS across the US. It is strongly suggested that you use our insurance script to check benefits. We do find USUALLY coverage is very good with low or no cost shares, but there have been plans that do not cover at all.
– Most Anthem plans have preventive coverage. You will need to ask (using our INSURANCE SCRIPT) about preventive coverage. ( Z71.3 ICD-10 diagnosis code specifically)
-Preventive coverage for most BCBS and Anthem plans is usually 100% and does not have a limit on the number of visits.
-BCBS Federal has 100% coverage, no limit on visits.
-If you do not have preventive nutrition benefits (ICD-10 code Z71.3), ask about medical coverage ( ie ICD-10 diagnosis codes for obesity, high cholesterol, diabetes, metabolic dysfunction etc. ). If you are covered for medical codes, we will need verification that you have these diagnoses from your primary care provider. You can ask your provider to provide us with these codes using our referral form.
-Most Anthem plans are currently covering telehealth, but please confirm with your plan.
– We are currently in the process of terminating our contracts with these plans , as such, we are no longer accepting new clients with these plans.
-Most of the UHC plans have coverage for both preventive AND medical codes.
– Most UMR plans require diagnosis codes and we will request you have a referral from your primary care provider.
-We do need a form with your ICD-10 diagnosis codes annotated. Your provider is welcome to fax over notes with codes documented, or you can use the form we have available.
-Usually, UHC will cover for an overweight or obesity code: BMI over 25 (overweight) or a BMI over 30 (obese).
These BMI-based codes combined with a cardiovascular risk factor diagnosis (high blood pressure, high cholesterol, heart disease, impaired glucose, diabetes, etc.) usually have 100% coverage.
-There is sometimes deductible and cost share / co-pay, but not always. You must check with your plan. You can use this script to check with your insurance.
-Most of these plans are covering telehealth, but please confirm.
-Medical nutrition therapy is ONLY covered with a diagnosis of type 2 diabetes or chronic kidney disease stages 3-5. These sessions will ALWAYS require a referral from the primary care provider to document these diagnoses. Please have them faxed over PRIOR to your initial appointment
-Medicare limits 12 units (3 sessions) for the first calendar year, total. Additional visits MAY be covered if your provider feels you still need nutrition counseling. They may then send us a new referral asking for additional units of coverage. Each new calendar year, you will start over with 8 allotted units (2 sessions), again with your provider having the ability of requesting additional units. Please reach out with any questions about Medicare coverage.
-Medicare plans are covering telehealth.
Medicare Advantage Plans: We bill the insurance company, not Medicare. If we are not in-network with the company that administers your advantage plan, you may not be covered. Some Advantage plans cover additional diagnosis codes but most follow Medicare guidelines (you are unlikely to be covered if you don’t have type 2 diabetes or chronic kidney disease).
Medicare Supplemental Plans: These plans only cover the additional cost that Medicare does not cover. This means that they will only cover the same codes as Medicare (type 2 diabetes and CKD).
-We are in network with NC Direct, WellCare, Carolina Complete, Amerihealth Caritas, Ambetter and Healthy Blue plans.
-We cannot accept your Medicaid plan if it is not a North Carolina plan
-These plans do require referrals and preauthorization by your primary care provider. The referral must come from a Medicaid-certified provider.
-Each plan allots a different number of units of service, so the authorization will determine how many visits you receive.
-Telehealth is usually permitted.
NOTE: Medicaid will only cover for age 20 or below.
Tricare Select: Tricare accepts medical codes only. This means we do need a referral form faxed over from your primary care provider. We do not need an official referral approved by Tricare, just the form with your ICD-10 codes annotated from your provider. If we do not have this, we cannot bill Tricare. We must have this form prior to your first visit.
Tricare Prime: You must have a Tricare-approved, formal referral to bill Prime. We are not an In-Network provider for Prime, so sometimes the referrals are not approved. For clients who do not have a Tricare-approved referral, but do have medical codes faxed from their primary care provider ( you can use this referral form), we can submit an out-of-network claim. These usually result in a deductible to be met by the patient, after which there is some coverage by Tricare (usually about 50%, but you must confirm with your plan).
-An alternate option for Prime patients is cash pay. Our cash pay triple package with military discount is $355.0 for the first 3 sessions. ( full triple price $395)
– FCC plans cover for preventive (ICD-10 code Z71.3) and medical codes (diagnosis of obesity, other metabolic conditions, etc).
-Please use the script to verify if your plan requires medical codes, or if they will accept the preventive code (Z71.3). If medical codes are required, we will need a referral form sent over from your provider.
-Most plans have unlimited visits, but please verify if this is the case for your plan.
-MedCost covers for preventive (ICD-10 code Z71.3) and medical codes (diagnosis of obesity, other metabolic conditions, etc).
-Please use the script to verify if your plan requires medical codes or will accept preventive ICD-10 code Z71.3. If medical codes are required, we will need a referral form sent over from your provider.
-Most plans have unlimited visits, but please verify if this is the case for your plan.
-Aetna does require medical codes so we do need a form with your ICD-10 diagnosis codes annotated. Your provider is welcome to fax over notes with codes documented, or you can use the form we have available.
-There is sometimes deductible and cost share / co-pay, but not always. You must check with your plan. You can use this script to check with your insurance.
-Most of these plans are covering telehealth, but please confirm.
-We encourage all Cigna clients use our insurance script to verify their coverage.
-Cigna plans will GENERALLY cover up to 3 preventative sessions ( ICD-10 code Z71.3) with CPT 97802 and 97803 if you also have a covered BMI code. We will need a referral from your PCM annotating your diagnosed BMI for claims.
-SOME Cigna plans will pay for more than three visits per year with medical diagnosis codes, please use the insurance benefits script to find out if your plan has this option.
-We encourage all Cigna clients to use our insurance script to verify these codes (97802, 97803) will be covered as in office visits, but also as virtual sessions, if you plan to be a virtual client. Virtual benefits vary from plan to plan.
What Our Clients Say
Elizabeth A.
“She was friendly, professional, refreshingly attentive, and caring. I appreciate how I was offered multiple directions and choices. It’s been gratifying to finally be heard, and to get insights into what is causing my hormone imbalances. I’m already starting to see improvements of my PCOS, blood sugar, weight, and mood.”
John S.
“I’m so glad to have found something that I’m excited about. I feel like I can trust both Erin and the process. Thank you!”
Michelle F.
“I am currently down 30 pounds and feel a lot healthier. I was used to suffering with constant bloating, heartburn, and anxiety, but they are all virtually non-existent now. I can’t wait to keep going.“
