Eating Disorder Nutrition Therapy Covered By Health Insurance

• As of summer 2024, 1199 now covers unlimited nutrition counseling visits without prior authorization as long as there is medical necessity (ie an eating disorder, BMI >25, diabetes, hypertension, etc.). We do need an ICD-10 diagnosis code from your physician (or mental health provider for eating disorder codes) to establish this medical necessity. We can obtain this either through a fax from your doctor’s office at 631-812-5292 prior to your first appointment or from a screenshot or download from your doctor’s client portal.
• To verify benefits, call the number on the back of your health insurance card and use this script: Checking Your Health Insurance Nutrition Benefits

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• As of 8/8/23 we no longer require a physician’s referral for billing most Aetna plans, however we do need an ICD-10 diagnosis code from your physician (or mental health provider for eating disorder codes). We can obtain this either through a fax from your doctor’s office at 631-812-5292 prior to your first appointment or from a screenshot or download from your doctor’s client portal.  
• In general, Preventive “Healthy Diet Counseling” is covered at no cost for people with “obesity” alone (BMI 30+), or “overweight” (BMI 25-29.9) who also have a cardiovascular risk factor (i.e. hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome).
• Most other diagnoses (including eating disorders) are covered as medical and may apply to deductible/copay/coinsurance.  Most Aetna plans cover up to 26 visits per plan year.
• Some Aetna plans do not have any nutrition counseling benefits, so it is important to verify benefits prior to your visits to avoid any surprise charges.
• To verify benefits, call the number on the back of your health insurance card and use this script: Checking Your Health Insurance Nutrition Benefits

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• Generally, at least 3 visits are covered in full each year. Many plans cover additional visits that may apply to deductible/copay/coinsurance. Many plans exclude eating disorders and diabetes from plan visit limits, so you may have unlimited visits.
• We will need an ICD-10 diagnosis code from your physician (or mental health provider for eating disorder codes). We can obtain this either through a fax from your doctor’s office at 631-812-5292 prior to your first appointment or from a screenshot or download from your doctor’s client portal.  
• Some Cigna third party administrator plans do not have any nutrition counseling benefits, so it is important to verify benefits prior to your visits to avoid any surprise charges.
• To verify benefits, call the number on the back of your health insurance card and use this script: Checking Your Health Insurance Nutrition Benefits
  
  

• We are in network through Horizon Blue Cross Blue Shield and are considered in network with most out-of-state BCBS PPO plans including Anthem BCBS (formerly Empire BCBS). We are not in network with HMO plans and may be considered out of network for some Federal plans.
• BCBS plans generally cover nutrition visits in full as a preventive service, however there are many different plans throughout the country and each plan is different so it is important to verify your benefits prior to your first visit.
• To verify benefits, call the number on the back of your health insurance card and use this script: Checking Your Health Insurance Nutrition Benefits
  
  

• NYSHIP generally covers unlimited nutrition counseling visits with a $25 copay per visit and no copay for members with a BMI of 25 or above, diabetes, heart disease, or current pregnancy.
• We will need an ICD-10 diagnosis code from your physician to bill with a BMI code of 25 or above, diabetes, heart disease, or current pregnancy. We can obtain this either through a fax from your doctor’s office at 631-812-5292 prior to your first appointment or from a screenshot or download from your doctor’s client portal.  

• As of 2024: Northwell Direct generally covers only 4 nutrition counseling visits per year with no exclusions.
• To verify benefits, call the number on the back of your health insurance card and use this script: Checking Your Health Insurance Nutrition Benefits

• We are considered out of network with United Healthcare and Oxford. These plans often have out of network benefits in which you pay the provider directly and then submit claims to your insurance company. Your insurance company then reimburses you for a percentage of your payment after deductible/coinsurance/copay.
• To verify benefits, call the number on the back of your health insurance card and use this script: Checking Your Health Insurance Nutrition Benefits

• This practice has opted out of Medicare and does not participate in Medicaid. For patients with these insurance carriers, we may be able to offer reduced fee sessions if available.

• We are considered out of network with all other healthcare plans. These plans may have out of network benefits in which you pay the provider directly and then submit claims to your insurance company. Your insurance company then reimburses you for a percentage of your payment after deductible/coinsurance/copay.
• To verify benefits, call the number on the back of your health insurance card and use this script: Checking Your Health Insurance Nutrition Benefits