Navigating insurance coverage and billing as a client is confusing and frankly, frustrating most of the time. As someone who was *very* in-over-her-head in her 20’s trying to understand coverage, I empathize with all those who struggle with understanding their coverage and service costs. I created this resource to help you better understanding your individual coverage so you can navigate your healthcare expenses more effectively.
What is insurance coverage for “Medical Nutrition Therapy”?
Medical Nutrition Therapy (MNT) refers to the coverage provided by health insurance plans for nutrition counseling and therapy services provided by a registered dietitian nutritionist to manage or treat specific medical conditions.
Many health insurance plans cover MNT as a part of “preventative care” care benefits. Most also cover MNT for specific medical conditions such as eating disorders.
All visits at Nutrition Elevated are billed to insurance as “preventative medical nutrition therapy” (because all nutrition counseling is preventative!) or “eating disorder nutrition therapy” (provided that the client has received an eating disorder diagnosis by a licensed provider.) In most cases, insurance coverage for visits billed under these two codes is really good.
Premiums: The amount of money you pay, typically on a monthly or annual basis, to maintain your insurance coverage. It’s essentially the cost of having insurance.
Deductible: The deductible is the amount you must pay out of pocket for covered services before your insurance starts to pay. For example, if your deductible is $1,000, you’ll need to pay $1,000 toward your healthcare expenses before your insurance begins to cover costs.
Copayment: A copayment, or copay, is a fixed amount you pay for covered services at the time of the visit. For example, you might have a $20 copay for a doctor’s office visit or a $10 copay for prescription medications.
Coinsurance: Coinsurance is the percentage of costs you pay for covered services after you’ve met your deductible. For example, if your coinsurance is 20%, you’ll pay 20% of the covered expenses, and your insurance will cover the remaining 80%.
Out-of-pocket Maximum: The out-of-pocket maximum is the most you’ll have to pay for covered services in a plan year. Once you reach this limit, your insurance company will cover 100% of the remaining covered expenses. This limit includes your deductible, copayments, and coinsurance, but it typically excludes premiums.
In-network vs. out-of-network provider
- An in-network provider has a contract with your insurance company to provide services at negotiated rates.
- When you visit an in-network provider, your insurance plan typically covers a larger portion of the cost, and you usually pay less out of pocket.
- An out-of-network provider does not have a contract with your insurance company.
- If you visit an out-of-network provider, you pay the provider directly, and then request reimbursement through your insurance company. More commonly, insurance companies will pay a smaller portion of a visit for an out-of-network provider compared to an in-network provider.
How can I figure out how much I’ll pay for each nutrition visit?
- Understand Insurance Coverage:
- Check your health insurance policy or contact your insurance provider to understand your coverage for nutrition visits. Visit the Financial FAQ page to find my “insurance script” that you can follow when calling your insurance company.
- Identify In-Network and Out-of-Network Providers:
- Does the provider accept your insurance? If yes, they are an “in-network provider.” If not, they are an “out-of-network” provider.
- Check Co-Payment or Co-Insurance:
- Review your insurance plan to determine the co-payment or co-insurance amount for visits to a dietitian.
- Co-payment is a fixed amount you pay for each visit, while co-insurance is a percentage of the total cost that you’re responsible for.
- Review Deductibles:
- Understand if your insurance plan has a deductible for visits to healthcare providers.
- A deductible is the amount you must pay out-of-pocket before your insurance coverage kicks in.
- Calculate Potential Costs:
- If you’re visiting an in-network dietitian:
- Add up the co-payment or co-insurance amount for each visit.
- Consider if you’ve met your deductible for the year.
- If you’re visiting an out-of-network dietitian:
- Understand the reimbursement rate your insurance provides for out-of-network visits.
- Calculate the percentage of the visit that you’ll be responsible for paying.
- If you’re visiting an in-network dietitian:
- Consider Other Factors:
- Remember to factor in not only the immediate costs but also the quality of care and convenience of the provider.
- In addition to cost, consider other factors such as the expertise and qualifications of the dietitian, the location of their practice, and any personal preferences you may have.