If you’re looking to work with a Blue Cross Blue Shield nutritionist at Plenish, we’re excited to help you thrive with your nutrition. Before you schedule a session, we ask that you confirm your nutrition benefits with your individual insurance plan. Before giving up, please read through this blog, it’s easier than it sounds!
Unlike Aetna, Cigna, and United Healthcare, Blue Cross Blue Shield operates under many different regional companies. For example: Anthem Blue Cross Blue Shield, CareFirst, Premera, Regency, Health First, and others. We are in network with most PPO plans and some HMO and EPO plans, depending on your location.
If you have a FEP plan with BCBS, you can skip checking your benefits because we have already verified that it is covered.
For other Blue Cross Blue Shield benefits, we do not check benefits on your behalf. Clients consistently receive more accurate information when they contact their insurance provider directly.
Verify your benefits prior to working with a Blue Cross Blue Shield Nutritionist
The best way to check your benefits is to call the number on the back of your card and speak with a representative. Clients have also had great success with using the chat function on their portal.
Give the representative accurate information. The answers they provide depend entirely on the details you share.
What to ask your Blue Cross Blue Shield Representative
“Hi, I’m calling because I plan to work with an in-network Blue Cross Blue Shield nutritionist, and I’d like to confirm my coverage for nutrition counseling.”
Then ask the representative:
- Do I have coverage for nutrition counseling or medical nutrition therapy (CPT codes 97802 and 97803)?
- Do I need a specific diagnosis for this benefit? If so, can you check diagnosis code Z71.3 for preventive nutrition counseling? You may need to pair it with a BMI code. Please check Z71.3 with Z68.24 to confirm if that combination is covered.
- Note for client: If you require a different diagnosis code, you may have one from your doctor that applies to nutrition visits. I’ve listed additional possible codes below.*
- Do I need prior authorization before scheduling?
- How many nutrition visits does my plan cover each year?
- What will my copay or coinsurance be for these sessions?
- Is there anything else I should know before scheduling an appointment with my nutritionist?
*Examples of diagnosis codes that Blue Cross Blue Shield may cover for nutrition visits:
E66.3 – Overweight
E66.9 – Obesity
E11.9 – Diabetes, Type 2
F50.022 – Anorexia nervosa, binge eating/purging type, severe
F50.012 – Anorexia nervosa, restricting type, severe
F50.20 – Bulimia nervosa, unspecified
F50.810 – Binge eating disorder, mild
K58.9 – IBS
Please note coverage is not guaranteed. Insurance companies occasionally provide incorrect information or process claims differently than expected. While we do everything we can to ensure claims are submitted properly, there may be situations where a copay, deductible, or out-of-pocket balance applies.
What you can do if your insurance does not cover nutritional counseling
It can feel disappointing to learn that your nutrition benefits may not apply to your sessions. If that happens, we offer additional options at Plenish.
We start with transparent, accessible pricing because we believe high-quality care should not be out of reach. You can view our pricing here.
If our standard rates still feel out of reach, we offer a limited number of sliding scale spots with select providers. Email us or text us to ask about current availability.
