Insurance Coverage Information

Out-Of-Network Benefit Information

Our practice is out-of-network with insurance providers and payment is due prior to your appointment.

If you have out-of-network insurance benefits, these may apply to nutrition services.

If so, you would pay us directly and then we provide you with a Superbill receipt that you can submit to your insurance company. Depending on your benefits, you may be able to receive full or partial reimbursement for your nutrition counseling sessions.

These benefits vary considerably between insurance companies and plans. However, many of our clients with out-of-network benefits have had success in receiving partial or full reimbursement. Others have had the cost of nutrition counseling applied towards their deductible, helping them to reduce medical spending across the course of the year.

We recommend calling your insurance company to ask about your specific coverage. They can inform you of whether you will receive any reimbursement for our services, or whether the cost can be applied towards any deductible. We have included the instructions on how to do this below.

How to Determine if you have out-of-network Coverage

Step 1: Call Your Insurance Customer Service Line

The phone number for customer service is generally located on the back of your insurance card. Call and ask to speak to the benefits department. If your employer provides your plan, your HR department may be able to call on your behalf.

 

Step 2: Ask The Following Questions About Your Benefits

  1. Are Medical Nutrition Therapy (MNT)/Nutrition Counseling covered by my out-of-network benefits? [Note: The procedure codes we use for MNT are: 97802 (initial assessment) and 97803 (follow-up visit).]
  2. Is coverage dependent on my diagnosis (ICD-10 diagnosis code)? Are there certain diagnosis codes that are covered or are not covered?
  3. Are there any out-of-network benefits for preventative care (Z codes)? If so, which Z codes and what are the requirements?
  4. Are out-of-network telehealth visits covered? If yes, what place of service (POS) code should my provider use?

 

Step 3: If There is an MNT/Nutrition Counseling Benefit - Ask About Restrictions 

  1. Are there a certain number of  nutrition visits per calendar year?
  2. Is there a deductible that I need to meet?
  3. What is my percentage of coverage? Is there a co-pay?
  4. Do I need a referral from my primary care provider?
  5. Do I need pre-authorization?
  6. Is there a maximum reimbursement allowed per unit? How long is each allowed visit?

 

Important Tips:

  1. Be sure to document everything. Write down the date, a reference number, who you spoke with, and every detail from the call.
  2. Ask them to send you the information in writing.

 

Other Notes:

You may be able to have the MNT benefits applied to the “in-network” benefit side of your insurance plan if they do not have a registered dietitian in their network or if you have an eating disorder and they do not have a registered dietitian who is a Certified Eating Disorder Dietitian (CEDRD). When insurance companies agree to cover an out-of-network practitioner under the “in-network” benefits, this is often called Gap coverage.

You may also be able to request a single case agreement for MNT depending upon your plan and diagnosis. Should you obtain a single case agreement or GAP coverage, we will require written documentation and information on copay, deductibles and how the insurance company would like to be billed for services.

 

Information You May Need:

  • Provider Name: Alissa Rumsey, RD
  • Business name: Rumsey Nutrition Consulting, PLLC
  • EIN: 99-0924766
  • NPI: 1649645235

Please don't hesitate to email us with any questions at hello@alissarumsey.com

Other Financial assistance options

Alternative Financial Assistance

If you do not have out-of-network coverage and finances are an issue, we do offer a limited number of lower-price nutrition coaching spots for people with at least one marginalized identity who are also low-income.

To inquire about financial aid availability and eligibility, please email hello@alissarumsey.com with the subject line 'scholarship request'.

 

Note: please consider donating to our scholarship fund if you have the means to pay it forward. Every little bit counts!