insurance

All insurance plans need MD referrals. Please have your doctor's clinic use this form.

Currently we accept:

PPO

Blue Shield of California

United Healthcare

Medicare 

Private self pay

HMO

Some IPA medical groups

(Will need authorization from IPA group)

 

Questions to ask your insurance

We appreciate you taking the time to determine your coverage. This will save us both a lot of time and should keep you from getting any surprise bills.

If you have further questions, feel free to email Sandra@wholenutritionwellness.com

The following are questions you should ask your insurance. Thank you.

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 initial consult & 97803 follow up consults.

What diagnosis will be covered? Some plans are very specific and only cover a few diagnosis

  • If you do have a medical diagnosis like overweight, obese, pre-diabetes, diabetes, hypertension, high cholesterol, chronic kidney disease, etc. ask if they will be covered.

  • If you do not have a medical diagnosis ask the representative if z71.3 dietary counselling will be covered

How many visits do I have per calendar year?

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

Do I have a deductible to meet?

  • In the event you have a deductible we will not be able to initially bill your insurance company directly. Therefore, payment of $160 is due at the initial visit and $120 is due at each follow up visit.

  • We will provide you the appropriate documentation (Superbill) to submit to your insurance company to show receipt of the services. This will allow you to “pay down” your deductible. Once your deductible has been met and you have nutrition services on your policy, we can then directly bill your insurance company.

Do I have a co-pay for nutritional counseling?

  • For most insurance companies we are considered specialists. Therefore, your specialist co-pay is probably applicable and is payable at the time of service. This information is often apparent on the front of your actual insurance card. 

 

Special Note: During the pandemic, most insurance also cover Telehealth (phone or virtual visits)

MEDICARE 

Medicare only allows nutrition reimbursement for Diabetic and Chronic Kidney disease patients with doctor's referral.