Even when a provider is preferred with an insurance company each contract is unique and may not cover a specific service. It is always best to avoid surprises to double check your specific insurance plan as we are not able check insurance coverage at this time. Below are tips to expedite your call to insurance. Insurance coverage is often specific to a diagnosis meaning that many insurance plans won’t cover general care provided by a provider unless there is a diagnosis they deem as necessary.
Instructions for Contacting Insurance
To speed up the call try to have some of the helpful information listed here nearby.
Step 1: Dial the phone number located on the back of your insurance card for customer service on the medical side of the insurance company.
Step 2: The customer service representative will ask about the service in question as well as your reason for the service. Ask what your insurance coverage is for sessions with Registered Dietitian/Nutritionist for an eating disorder or for diabetes care.
Step 3: Insurance companies use numeric codes to designate each service and ICD-10 to designate each diagnosis. For your information, insurance service codes (CPT code) for billing time with a Registered Dietitian/Nutritionist are 97802 (assessment session) and 97803 (all follow up sessions).
Step 4: In addition to the service, a diagnosis code is also required by all insurance companies for each session that is billed. Many clients I work with have an eating disorder or diabetes diagnosis (because these are the areas of my professional focus) and each diagnosis has a corresponding ICD-10 code. You don’t have to know the specific code for your diagnosis or know your diagnosis but it may speed up your call if you do. For your information, the diagnosis code for eating disorders starts with F50 and then we add more specific information to specify symptom presentation. For example the ICD-10 diagnosis code for anorexia nervosa code F50.01 or the code for bulimia nervosa is F50.02, and the code for binge eating disorder is F50.81. If you are not sure of your specific eating disorder diagnosis you can use a more general code for other specified eating disorder or F50.89. For Type 2 Diabetes to diagnosis code is E11.9. All of the ICD-10 codes are listed online.
Important Questions to Ask
While speaking to your insurance company be sure to ask about whether or not this service applies to your deductible, how much of the deductible you have left to pay, how many sessions they will cover, whether or not you have a co-pay or co-insurance with each session and if you do what is your cost. Please keep in mind that deductibles often re-start at the beginning of the calendar year.
We are only able to bill for issues that we address in session. The provider (Juleeanna) will determine whether or not your symptoms meet criteria for the diagnosis and coordinate care with other providers on your team. If your physician or therapist have referred you they will usually include a corresponding diagnosis which frames the focus of our sessions.