Insurance Verification Worksheet

I am in Network with Blue Cross Blue Shield.

Please be aware that insurance companies will frequently give out incorrect information regarding nutrition counseling coverage. I am happy to submit the claims for your visits; however you should be aware that benefits for nutritional counseling can vary greatly among individuals. Not all policies contain benefits for nutritional counseling. 

Here you will find a worksheet that will help you navigate the insurance verification process.

When calling your insurance company be sure to tell them that you are seeing an in-network registered dietitian. 
My NPI (national provider identification)  number is 1033419858

1. Do my benefits include nutritional counseling? (Procedure codes 97802, 97803, S9470, 99404)_________

2. If yes, am I covered under both my preventive and medical services? Preventive ____.  Medical____

3. Do you cover the preventive diagnosis code Z71.3?_______

4. Are there any exclusions or limitations (such as limit to number of visits)? ______

5. Are my visits subject to a deductible? If yes, has my deductible been met for the year?______

6. Am I responsible for any copay or coinsurance for the visit?____________