1. What Are Out-of-Network Benefits?

Out-of-network benefits allow you to see healthcare providers who do not participate directly with your insurance plan. Many insurance plans offer partial reimbursement for services provided by out-of-network providers. The percentage of reimbursement varies depending on your specific plan.

Key points to understand:

• You typically pay the provider upfront and submit a claim to your insurance for reimbursement.

• Deductibles for out-of-network services may differ from in-network deductibles.

• Some plans cover a percentage of the cost after you meet your out-of-network deductible.

It’s important to contact your insurance company to verify your out-of-network benefits and understand your coverage.

2. Why Doesn’t Your Practice Accept Insurance?

Our practice’s decision not to contract with insurance companies is rooted in providing the highest quality care for our clients.

Here’s why:

• Personalized Care: Insurance companies often impose limits on the length or frequency of sessions, which may not align with the individualized care needed for eating disorder recovery and postpartum support.

• Specialized Expertise: Our practice focuses on treating complex conditions like eating disorders and supporting new parents through the perinatal period. These areas often require in-depth, nuanced care that doesn’t fit into the generic frameworks dictated by insurance companies.

• Health At Every Size Approach: Insurance companies often prioritize metrics like Body Mass Index (BMI), which conflicts with our philosophy.

  While we don’t bill insurance directly, we’re happy to provide superbills, which contain all necessary information for you to seek reimbursement from your insurance company.

3. How Can I Maximize Reimbursement for Medical Nutrition Therapy?

Advocating for yourself with your insurance company is essential. Here are steps to improve your chances of reimbursement:

Questions to Ask Your Insurance Company:

1. Coverage Details:

   • “Does my plan cover Medical Nutrition Therapy (MNT)?”

   • “Is MNT covered for diagnoses such as eating disorders, gestational diabetes, or other medical conditions?”

2. Out-of-Network Benefits:

   • “What percentage of out-of-network services is reimbursed?”

   • “What is my out-of-network deductible, and how much have I met?”

3. Documentation Requirements:

   • “What documentation is required for reimbursement (e.g., superbills, referral from a doctor, proof of medical necessity)?”

4. Session Limits:

   • “Are there any limits on the number of nutrition therapy sessions covered annually?”

5. Submitting Claims:

   • “What is the process for submitting a claim?”

   • “What is the timeline for reimbursement once a claim is submitted?”

Tips for Submitting Claims:

• Obtain a superbill from our practice after each session.

• Include a cover letter summarizing your request and relevant medical diagnoses.

• Follow up with your insurance company if you encounter delays.

4. Additional Resources and Support

We’re here to support you in navigating this process. If you have questions about superbills or documentation, please don’t hesitate to reach out. Together, we can work toward ensuring you receive the care and support you deserve.