Checking Your Out of Network Insurance Benefits

OUT OF NETWORK BENEFITS

At this time, FREE Method Nutrition does not accept insurance at this time. If you have out of network benefits, you may be able to use these towards our sessions together. How that would work is you would pay for the session in full, and we would issue a superbill that you will submit to your insurance company. Depending on your benefits, you may be eligible for partial or full reimbursement.

DETERMINE YOUR OUT OF NETWORK COVERAGE

Call the member services number on the back of your card. Ask to speak to the benefits department. Ask them the following questions:

  1. Does my plan cover out-of-network nutrition counseling? (CPT codes: 97802 and 97803)

    • If yes:

      • How many how many sessions are covered per year?

      • Is it covered in full or partial?

  2. Is coverage dependent on my diagnosis (ICD-10 diagnosis code)? Are there certain diagnosis codes that are covered or are not covered?

    • Does my plan provide out of network coverage for preventive services (diagnosis code Z71.3 or any other Z codes) or does my plan only cover services deemed “medically necessary”?

  3. Do I have a deductible to meet first? If yes, how much is your deductible and how much of the deductible have you met?

  4. Do I have a co-pay or co-insurance for outpatient nutrition counseling? If yes, how much is it?

  5. Do I need a physician referral? If you need a physician referral, this must be brought to your first appointment or emailed to our office manager (hello@freemethodnutrition.com).

  6. My dietitian provides superbill receipts for our sessions. How do I submit these for reimbursement, and how long does the process take to receive financial return?

  7. Record the representative’s name and a reference # when checking your benefits. This information will be necessary if you ever need to dispute a rejected claim.

NOTE

If you do not have out of network coverage, you may be able to have the benefits applied to the “in-network” benefit side of your plan. You will want to ask if you can obtain a single case agreement (SCA) or GAP coverage.