Nutrition therapy can be a helpful component in medical therapy, but often it is not covered by insurance. It cannot only improve an individual’s health, but it also can save money on health-care costs. According to a report by the National Academy of Sciences’ Institute of Medicine (IOM), getting nutritional therapy is cost effective. Dietitians can help people manage conditions such as high-blood pressure, high cholesterol, kidney and heart problems and diabetes. A study by the Department of Veterans Affairs Medical Center in Long Beach, Calif., showed that more than half the people who saw a dietitian only a few times lowered their cholesterol so much that they no longer needed cholesterol medication. Nutrition therapy saved the health-care system about $60,000 per year in prescription drug costs. According to the IOM report, nutrition therapy can mean a savings of millions of dollars. For example, if Medicare beneficiaries with high-blood pressure received nutrition therapy, health-care costs over a five-year period could be cut by an estimated $52 million dollars. These cost savings could be increased for every disease nutrition therapy was applied to. The IOM report’s authors concluded that Medicare should cover nutrition counseling. Unfortunately, most insurance companies do not cover nutrition counseling but, fortunately, more and more insurance carriers are now seeing the advantages of seeing a nutritionist (http://www.medicinenet.com/script/main/art.asp?articlekey=50695&pf=3&page=1).
- Moderately Easy
- Insurance company information
- Doctor’s contact information
How to Get Insurance Coverage for Nutrition Counseling
Insurance may be more likely to cover nutrition therapy for certain medical conditions such as diabetes, obesity, coronary artery disease or high-blood pressure for which diet therapy and modification is recognized as one aspect of treatment (Dr.Weil.com, http://www.drweil.com/drw/u/QAA400314/nutritional-consultations).
First call or see your doctor to see if you can get a referral for a dietitian. This will increase the likelihood nutrition therapy will be covered by insurance.
Call, go online to the insurance companies website or email your insurance provider to find out what coverage they offer for nutrition counseling. Some insurance companies might cover it entirely and some might offer a 10 to 20 percent discount.
A good bet for getting nutrition visits covered by insurance is to see a registered dietitian. You can contact the American Dietetic Association’s Nutrition Network Referral Service at (800) 366-1655 (weekdays from 9 a.m. to 4 p.m., Central Standard Time) for contact information for dietitians in your area ( http://www.medicinenet.com/script/main/art.asp?articlekey=50695&pf=3&page=1).
Even if your insurer says your policy doesn’t cover dietary counseling, send in the paperwork anyway and see what happens. If you have a doctor’s written referral to a dietitian, include a copy. Also include a letter, signed by both your dietitian and your doctor, detailing the medical need for your treatment.
In correspondence refer to dietitian visits as “medical nutrition therapy” or nutrition “management” or “treatment.” Try to avoid the term counseling as it does not imply a medical necessity.
Instead of speaking with an adjuster, ask your dietitian to talk to the medical director of the health plan to consider covering nutritional counseling, says Michele Mathieu, Director of Health Care Financing at the American Dietetic Association.
Emphasize the dollar savings. Have your dietitian, doctor or both detail the progress you have been making and how much money is being saved as a result. For instance, if you have lost weight or been able to reduce medication, explain this to them. Add up the actual dollars that have been saved. Many insurance companies are demanding to see actual results from dietitian visits before they will begin to cover them. They might start authorizing them if they see progress is being made.
Be persistent. Even if your claims are rejected, continue to submit them after every visit, especially if you are getting better. If you are persistent you are more likely than not to get it. Even if you do not receive insurance coverage, you will be making the insurance company aware of the effectiveness of nutrition, and with each claim filed, you will have cast a vote for insurance coverage for nutrition therapy.