Insurance Coverage

Insurance coverage of my services will depend upon what your insurance allows. I am a provider of most health insurances, if they allow Registered Dietitians to be providers. The services of a Dietitian are called “Medical Nutrition Therapy.”

In most cases, a medical diagnosis is needed for coverage. Also, your physician will need to refer you to me. I can help answer any questions you have about this and I can ask your physician for a referral for you.

Medicare Coverage: I am a Medicare Provider for patients who qualify for the “Medical Nutrition Therapy” benefit with Medicare, which is for diabetics and people with pre-end stage kidney disease only. (See below for definitions of “diabetes” and “pre-end stage kidney disease.”)

Medicare Secondary Insurance: If you are a Medicare patient and your physician referred you to me, and you do not have diabetes or kidney disease, your secondary insurance will not cover your visit to see me. Secondary insurances only cover the services that Medicare “allow.”

Other Primary Health Insurances: Several other health insurances also cover my services, including Aetna, Meritage Medical Network insurances (with pre-approval), United HealthCare (with a “gap exception” established before first visit), Anthem, Blue Cross, Medicare, SCAN (with pre-approval)–and other health insurances–all with specific conditions of coverage.  It is best to find out about coverage before your first visit with me. Please ask me for more details–this list changes frequently.

“Gap Exception:” Some insurance companies do not have any Dietitian providers–but we can sometimes arrange for a “gap exception” for coverage with those insurances. A “gap exception” is when an insurance company does not have any Dietitian providers, but because your doctor referred you to a Dietitian, they are sometimes willing to provide the Dietitian service for you–making an “exception” and filling a “gap” in their coverage for you.

Call Your Insurance First: To be sure your insurance will cover your visit to see me, before our first visit, I highly recommend that you call your insurance company and ask if they will cover your visit to see me  for your medical diagnosis and with a referral from your doctor. Some insurance companies will cover some diagnoses and not cover others. If you call them we will know if we need to do anything before your visit to obtain insurance coverage for you.

Unfortunately, even if your physician referred you to me for services, some health insurance companies do not cover the service. I am happy to try and help you obtain coverage in whatever way I can.

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Definitions of Diabetes, Pre-Diabetes and Kidney Disease

Diabetes is defined as a fasting blood sugar ≥ 126 mg/dL, on two different occasions, an A1c ≥6.5%, or a 2-hour post-glucose challenge result ≥ 200 mg/dL on two different occasions, or a random glucose over 200 mg/dL for a person with symptoms of uncontrolled diabetes.

Pre-diabetes is defined as a fasting blood sugar of 100 mg/dL to 125 mg/dL, an A1c of 5.7% to 6.4%, or a 2-hour post-glucose challenge result of 140 mg/dL to 199 mg/dL. Pre-diabetes is not covered by Medicare but is covered by some other insurances.

Pre-End Stage Kidney Disease: For the pre-end stage kidney disease diagnosis, a person’s eGFR (estimated Glomerular Filtration Rate) needs to be between 13 and 50 ml/min/1.73 m². Patients with an eGFR < 13 ml/min/1.73 m² will usually receive services from a Dietitian at a dialysis clinic and will be covered by their insurance for that.

© Copyright 2010 – 2017 Ann M. Del Tredici