To verify your benefits, utilize this form.

The easiest way to answer this question is to call the Customer Care phone number on the back of your insurance card. If the representative asks for a CPT code, provide them with the following codes: 97802 and 97803. If they say there is no coverage using 97802 and 97803, NEXT ask them to check if you have coverage for the following CPT codes: 99401, 99402, 99403 and 99404.

If the representative asks for the name of the provider, give them your dietitian’s name, followed by the NPI number listed below.

Jessica Brinling NPI 1154910214

If the dietitian is NOT covered under your insurance plan and is considered an out-of-network provider, you will need to pay for your nutrition counseling visit at the time of service. The fees are:

Initial visit (1 hour): $150.00

Follow up (30 min): $70.00

The dietitian can provide you with a “superbill”, which can be submitted to your insurance company for reimbursement. Make sure to ask the representative how reimbursement works under your current insurance policy. We accept cash, check, HSA/FSA cards and all major credit cards.

If a diagnosis code is requested (also known as the ICD-10 code), provide the representative with the following code: Z71.3. We aim to code your visit with this preventative code (Z71.3) to maximize the number of visits you receive from your insurance company.

The representative will let you know how many visits insurance will cover. Depending on your insurance, the number of visits can vary from 0 up to unlimited visits based on medical necessity.

In the event you have a deductible, you will be required to pay for your nutrition counseling visit in full at the time of service. We will provide you with the appropriate documentation to submit to your insurance company to show receipt of the services you received and paid for. This will allow you to “pay down” your deductible. Once you meet your deductible, we will be able to bill your insurance company directly.

For most insurance companies, dietitians are considered specialists. Therefore, your specialist copay is applicable, meaning you may need to pay a certain amount towards your nutrition counseling visits. This information is often displayed on the front of your insurance card.

However, because we often aim to bill your insurance with preventative nutrition counseling, the copay is often not applicable. We generally wait for the insurance claim to be processed to determine whether or not you have a copay and then charge the credit card you have on file as the copay amount.

Many insurances cover telehealth services, so it’s important that you call your insurance company to verify telehealth coverage. It may be possible that you will have a copay for using telehealth services, so please find this information out PRIOR to your first visit. If you choose telehealth, we will meet through a HIPAA-compliant virtual platform called Simple Practice. If you choose to meet in person, we will meet at Thrive Therapy Space at 3910 Caughey Road Suite 200, Erie, PA 16506.

Please note it is the patient’s responsibility to call their insurance company PRIOR to your visit to confirm coverage.

Do I have nutritional counseling coverage on my insurance plan?

If the insurance company asks for a CPT code please provide them with the following codes 97802 & 97803. If they say you do not have coverage using those codes NEXT ask them to check your coverage for the following CPT codes: 99401, 99402, 99403 and 99404. We also can bill for S9470 if it is covered on your policy.

Will my diagnosis be covered?

If the representative asks for a diagnosis code (aka ICD 10 code) – please tell them the visit is coded the ICD 10 code: Z71.3

If they don’t accept Z71.3 then provide them with Z72.4 and see if they will cover that diagnosis instead on your plan.

If you are overweight, obese, have pre-diabetes, diabetes, hypertension, or high cholesterol you may want to see what your coverage is for these diagnoses as well.

We always code your visit using preventative coding (if applicable) to maximize the number of visits you receive from your insurance carrier. However, if you ONLY have a medical diagnosis (for example: IBS, and you are not overweight or have CVD risk factors) your insurance may impose a cost-share for your visit either in the form of a deductible, co-pay or co-insurance.

How many visits do I have per calendar year?

Your carrier will let you know how many visits they are willing to cover. Depending on the carrier the number of visits vary from 0 to unlimited depending on medical need.

Do I have a cost-share for my nutrition visit?

A cost-share is the amount you will need to pay as required by your particular insurance plan towards your services. A cost-share can be in the form of a deductible, co-pay or co-insurance.

We will always bill under your insurance policy’s plan under your preventative benefits if your plan allows. With that being said, if you have preventative benefits, there is often NO cost share for you associated with the visit. Once again, this is something YOU do want to ask prior to your visit.

In the event you have a cost-share, we will initially bill your insurance company directly. Once we receive the EOB describing your responsibility as the patient, we will bill the credit card on file.

For most insurance companies, dietitians are considered a specialist. Therefore, your specialist co-pay is applicable and is payable at the time of service. This information is often apparent on the front of your actual insurance card. However, often because we bill your insurance with preventative counseling the co-pay is often not applicable.

We generally wait for the claim to be processed to determine whether or not you have a co-pay and then charge the credit card you have on file with us the co-pay amount.

Summary of questions to ask to verify your nutrition benefits

Do I have coverage for nutrition counseling?

Do I need a referral to see a Registered Dietitian?

Are my diagnoses covered on my particular plan?

How many visits per calendar year do I receive?

Do I have a cost-share for these services?

Is there an associated cost for me if I choose to have the appointment as a telehealth visit versus in-person visit?

What is the reference # to the call?

If you have any questions after verifying your benefits, Great Lakes Nutrition is happy to help! Please email Jessy Brinling at jessybrinlingnutrition@gmail.com.