How we work
Insurance
Our goal is to be in network with as many insurance companies as possible and to help patients use their insurance benefits.
Most of our patients do not have any out of pocket costs.
Commercial Insurances
We are in network with the folowing insurance companies:
- Aetna
- Aetna – Meritain
- Blue Cross Blue Shield
- Blue Cross Blue Shield – Federal Employee Program (BCBS FEP)
- CareFirst
- Cigna
- Johns Hopkins EHP
- GEHA
- United Healthcare
- United Healthcare Shared Services
- United Healthcare Surest
- UMR
Maryland Medicaid & MCO Plans
We are in network with the folowing insurance companies:
- Aetna Better Health of Maryland
- CareFirst Community Plan
- Maryland Physicians Care
- MedStar Family Choice
- Maryland Medicaid
- Maryland Medicaid – Rare and Expensive Case Management (REM) Program
- Priority Partners
- United Healthcare Community Plan
- Wellpoint (formerly Amerigroup)
Medicare
We are network with Medicare. Medicare only covers visits for Diabetes and Chronic Kidney Disease.
If you have Medicare as a primary or secondary insurance, or if you have a Medicare Advantage plan, please discuss this with us in detail.
Provider Networks
We are in network with First Health – a large national preferred proider organization (PPO) network. Coverage and benefits are determined by your health insurance company.
Not In Network
We are not in network with Kaiser, Humana, Jai Medical Systems, TRICARE, or US Family Health Plan.
We can not bill for any services when any of these are your primary insurance.
Covered Services
The following information is for general information only and not a guarantee of coverage.
| Insurance Plan | Important Information |
| Aetna Better Health of Maryland | Referral Required. Plan covers visits for Pregnancy, Diabetes, and Children up to age 20. |
| Maryland Physcians Care | Referral Required. Plan covers visits for Pregnancy, Diabetes, and Children up to age 20. |
| MedStar Family Choice | Referral & Prior Authorization Required after 3rd visit. |
| Priority Partners | Referral & Prior Authorization Required. Plan covers visits for Pregnancy, Diabetes, Bariatric Surgery, and Children up to age 20. |
| United Healthcare Community Plan | Primary care provider must provide a Referral in the UHC Provider Portal. Plan covers visits for Pregnancy, Diabetes, Bariatric Surgery Preparation, and Children up to age 20. |
| Maryland Medicaid | “Straight Medicaid – Red and White Card” only – does not cover nutrition services. Services available through Managed Care Organization (MCO) plans and Rare and Expensive Disease Management Program (REM). |
| Union Plans & Self-Funded Plans | Coverage varies greatly. We will contact you plan for more information. |
| Aetna, Cigna | Referral not required but medical diagnosis is required. Please provide a referral or medical records. Preventative Benefits may apply. |
| All Commercial Insurances | We will attempt to bill your Preventative Benefits as this helps to avoid copays and deductibles. Please provide a referral or other medical records that document any of the following conditions: Overweight, Obesity, Pre-Diabetes, Diabetes, High Blood Pressure, High Cholesterol. |
Checking Your Benefits
We will do our best to help you use your insurance. However, insurance plans vary widely. We encourage you to call your insurance company to check on your benefits.
Please ask these questions:
- Does my plan cover nutrition counseling?
- Does my plan cover CPT Codes 97802 & 97803?
- Will I have copay?
- Does a deductible apply?
- How many visits are covered per year?
- Do I need a referral?
- Do I need a prior authorization?
- Does my plan have Preventative Benefits under the Affordable Care Act?
- Is the diagnosis code Z71.3 covered?
- Do I have specific coverage for any of these conditions: overweight, obesity, pre-diabetes, diabetes, hypertension, high cholesterol.
- Ask for a reference number.
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