Coding and Billing Assignment

I called my insurance company, Blue Cross Blue Shield, and asked about what services

provided by dietitians were covered under my plan. The agent I spoke with was not very helpful,

however, I still managed to receive some information about my plan’s coverage. After the agent

told me about the two services that were covered I was a little shocked because I thought that

more services would be covered under my plan. The agent said that these were the only two

services that were defiantly covered, and that other services depended and that I needed a CPT

code to check the coverage.

First, the agent spoke to me about nutrition counseling provided by only a licensed

nutritionist or a registered dietitian. If the provider was in network, an office visit would be

covered but require a $45 copay. Therefore, the out-of-pocket would be $45. On the other hand,

if the provider was out of network, I would need to have met my $1550 deductible and then 60%

of the cost would be covered by my insurance. This means that the remaining 40% would be my

out-of-pocket cost. If my deductible was not met yet then the amount remaining for me to meet

my deductible would be my out-of-pocket cost. The agent also explained that there was no limit

on the amount of visits. Next, the agent explained coverage for diabetes education. If the

education was being provided by a dietitian within network and during an office visit the copay

would be $45. Therefore, my out-of-pocket cost for this service would be $45. If the education

was taking place within network but in an outpatient setting, insurance would cover 80% if my

$400 deductible was met. This means that my out-of-pocket would either be the remaining 20%

if my deductible was met, or the difference left of my deductible if it was not met yet. To

continue, if the provider was out of network, 60% would be covered by insurance if my $1550

deductible was met. This means that my out-of-pocket cost would either be the remaining 40%
not covered by insurance or the remaining deductible if it was not met yet. There was also no

limits on this service.

There are some implications regarding RDN care, advocacy and public policy. First, if

most services provided by RDN’s are not covered, this can significantly harm our profession.

Without insurance covering the cost of services, it can become pretty expensive and out of many

patients’ budgets. For this reason, patients may choose to not receive several services that

dietitians provide due to the fact that it is too expensive and their insurance company does not

cover it. In turn, this can harm our profession because our number of clients will severely

decline. A decreased number of patients will lead to a decline in the need for dietitians as well.

This is why it is important to advocate and be involved in public policy. Public policies impact

insurance companies, and what services they cover, which in turn affects our profession.

Advocating for more coverage is important to our profession because it will allow for more

patients to receive our services and not have to worry about cost.