Insurance Guide to In-Network Benefits

Please use the guide below when calling your insurance company to verify your insurance benefits. Erin Falco RDN INC does not verify insurance benefits for patients. 

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How To Verify Your Insurance Benefits: 

  Step 1:

  When you get on the phone with an insurance representative ask the following: 

  1. "I am calling to see if a certain CPT CODE  (97802 (Initial Visit) and 97803 for the follow up visits) is covered under my plan?"

  2. "Is the Nutritional Counseling considered preventative?" If so, which diagnosis codes does that include?

  3. "Do I need a medical diagnosis to be covered under my plan?"

    • If so, please be sure to obtain a diagnosis code from your medical provider, or use some of the following examples associated with the reason for your visits:

      • Obesity: E66.9, overweight: E66.3, Morbid obesity: E66.01

      • High Cholesterol: E78.5

      • Diabetes: E11.65

      • Eating Disorder: F50.9

      • Mixed Irritable Bowel Syndrome: K58.2

      • General nutritional counseling, preventative: Z71.3 (as of 2/22/2022 Cigna does not allow this general code.  Aetna also does not accept this code. For Aetna- Z71.9 may be accepted or you will need a diagnoses code to be covered for nutritional counseling.  Medicare also does not accept this code.

  Step 2: 

  If you are covered, please also ask these additional questions: 

  1. How many visits allowed per year?  (Typically these are the allowed visits- You will need to call your insurance to verify exact coverage- all plans are different and vary depending on diagnoses.)

  • Cigna- typically allows 3 visits/year

  • Aetna-Can allow anywhere from 3, 12 or 22 visits/year depending on diagnoses. Z71.3 (general nutritional counseling) is not a covered diagnoses

  • Medicare- 3 hrs/year for the first year and 2 hrs for the following year for only Diabetes or kidney disease

  • Horizon Blue Cross Blue Shield of NJ- 3 visits/year for all diagnoses accept eating disorder- typically unlimited visits- the diagnoses needs to come from a therapist or MD. 

  • Other Blue Cross Blue Shield plans- Out of state- coverage varies greatly- visits can be 3 to unlimited depending on plan and diagnoses

  • Amerihealth- 3-6 visits/yr

  Step 3:

  Other questions to ask:

  1. Do I have to meet a deductible first?

  2. Is there a copay and/or what % of the service is covered?

  3. Are virtual and in person appointments covered?

  4. Is there a referral or pre-authorization needed?

  5. Provide our office information- Erin Falco RDN INC at 258 Broad Street, Red Bank, NJ, 07701

  6. Ask for the reference number of your conversation with your insurance company. THIS IS VERY IMPORTANT!

  7. Be sure to provide our office with the reference number you obtained when calling to schedule your first appointment - you will need this number in case your visit gets denied.

Ready to Get Started?

Book a free 15 minute discovery call to discuss how our team of RDs can help your specific goals.
If you plan to apply insurance coverage to your sessions, please have a copy of your ID, credit card, insurance card, and all necessary insurance benefits information ready 
before calling to schedule (as outlined below). Please note: Erin Falco is not accepting new patients until August 2022. Once scheduled for August, you will be added to a waitlist if a cancellation occurs. All forms must be filled out to be added to the waitlist.