Use this easy three-step process to find out if you’re covered!

It is recommended to verify your insurance benefits before your first session as your coverage could have specific qualifications. Please see below for the questions to ask your insurance representative before making an appointment, as you will be responsible for any fees not covered by insurance.

Step One: Locate the phone numbers on the back of your health insurance card and be ready to share the reason for calling (asking about nutrition counseling benefits) and any medical/nutritional diagnoses. Use this form to fill in as you go.

Step Two: Call the member services number on the back of your card and ask:

• Does my plan cover outpatient nutrition counseling? (CPT codes: 97802 and 97803)

  • If yes, is there a limit on the number of allowed sessions?

  • If no, ask them to check your coverage for CPT code 99404.

• Does my plan only cover visits that are “medically necessary” or does it also cover preventive services? (code: Z71.3)

  • Preventative diagnosis code: Z71.3 - dietary counseling and surveillance

  • Medical diagnosis code examples: eating disorders, diabetes, cardiovascular, overweight/obesity and BMI codes*

• Does my plan cover telehealth for nutrition counseling? (location code: 10 for Anthem/BCBS and UHC; location code: 02 for Aetna and Cigna)

• Do I have a deductible to meet first?

  • If yes, how much is my deductible?

  • How much of the deductible have I met?

  • Do I have a co-insurance to pay after the deductible is met?

• Do I have a copay for outpatient nutrition counseling?

• Do I need a physician (PCP) referral?

  • If yes, ask if there are specific diagnoses that are required in order to have coverage for sessions. You can request a referral from your doctor and have it faxed to us at 719-890-7320. We must have the referral BEFORE your first appointment in order for your visits to be covered.

  • If you have an HMO plan, the referral must come from the PCP on file with your insurance.

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

Step Three: Make an appointment and get started!

​Please Note: Insurance providers sometimes say one thing and then commit to another. This form can be helpful to facilitate a conversation to verify your benefits; however, we are not held responsible for charges that your health insurance may bill as this is, unfortunately, out of our control. Any costs not covered by insurance are the responsibility of the patient.

*Maddox Nutrition takes a weight-neutral approach to nutrition support and we do not believe that weight is a primary indicator of health. However, some insurance companies base their nutrition benefits off of weight/BMI for diagnosis codes related to “overweight” or “obesity". It is up to you to share weight/BMI/”obesity” diagnoses information with your insurance representative in case coverage differs based on these codes.