In today’s profit-driven world, one of the major considerations of anyone who is thinking of becoming any type of healthcare practitioner is insurance reimbursement. Because nutritionists are classified as healthcare practitioners, a nutritionist’s services are generally covered by health care insurance. In fact, many clients are not financially able to seek help for their nutrition-related issues unless their health insurance will pay for at least part of the services, as they would not be able to afford these services otherwise.
The fact that a nutritionist’s services must be covered by insurance has been codified into the Affordable Care Act (ACA), enacted in 2010. If a nutritionist is in a health insurance plan’s network, their preventive services must be covered, under this act. This applies to all Marketplace plans under the ACA as well as to many other health care insurance plans. The ACA lists a few different services provided by nutritionists that are covered, including:
- Diet counseling for adults with a higher risk of contracting chronic disease
- Obesity screening and counseling
Let’s examine how, when, and under what circumstances health insurance will cover the services of a nutritionist. For readers who are considering becoming nutritionists, we will also look at when it is optimal for nutritionists to accept insurance from clients and when it is not.
Nutritionists Who Are Credentialed Registered Dietitian Nutritionists (RDNs)
Nutritionists who have earned the right to be called Registered Dietitian Nutritionists (RDNs) will usually have their services covered by health insurance. This does not mean that a client may choose any RDN and have their services covered, however. Each insurance plan will cover only those RDNs who are within their network of participating providers. Not all services offered by an RDN will be covered either. For example, Medicaid, the governmental insurance plan that covers those who are within the lowest income bracket, must offer coverage of the above-mentioned preventive services offered by RDNs. They do not have to cover other services offered by RDNs, however, such as those for eating disorders. Rules and regulations on what Medicaid will cover vary from one state to another, and each state’s Medicaid and CHIP (Children’s Health Insurance Program, the version of Medicaid covering eligible children) is constantly changing. Medicaid provides a webpage in which you can look up the profiles for Medicaid and CHIP for each state to see who is eligible and what services are covered.
Medicare, the governmental health insurance plan for Americans aged 65 and above, will usually cover the preventive nutritional services of an RDN, but this, too, varies by state. Consult this Medicare page for information on the services covered within your state.
Private health care insurers, as well, will usually cover nutritional counseling that is designed to prevent disease if it is offered by a credentialed RDN. If you are looking for a nutritionist’s services and are uncertain whether your health insurance plan covers nutritionists, call them to check.
Nutritionists With Other Credentials Such as CNS or CCN
If a nutritionist is not an RDN but, rather, is a Certified Nutrition Specialist (CNS) or Certified Clinical Nutritionist (CCN) or holds another credential, their services may or may not be covered by health insurance.
A CNS is certified by the Board for Certification of Nutrition Specialists of the American Nutrition Association. Their nutritional counseling services may be covered by health insurance, on a state-by-state basis. This means that if your state’s rules and regulations say that a CNS may provide such services, there is a greater chance that those services will be covered by health insurance. Again, if you are seeking the services of a CNS, check with your insurer to make sure that these services will be covered.
A CCN has been certified by the Clinical Nutrition Certification Board (CNCB). If a state’s laws recognize CCNs as nutritionists, it is more likely that their preventive nutritional services will be covered by insurance. Check with your health insurance company to see if a CCN, or a nutritionist with any other credentials, are included within their network of providers.
Nutritionists With No Credentials
The services of nutritionists who have no credentials at all, or who have credentials that are not widely recognized, are likely not covered by health insurance. This is because credentialing acts as a vetting system for nutritionists, letting health care insurers and clients know that credentialed nutritionists have met certain educational, experiential and examination standards. Uncredentialed nutritionists, or nutritionists with sketchy credentials, have met no such standards, and typically will not be covered under health insurance, but instead, will charge clients out-of-pocket fees for services.
Should I, As A Nutritionist, Accept Health Insurance?
If you are pondering becoming a nutritionist, or already are one, you might be wondering if you should accept health insurance, or if it will just be too much of a hassle and whether you should instead just charge your clients fees-for-services. There are pros and cons to both sides of this decision. (Of course, if you are even considering accepting health insurance, you should be credentialed and have those credentials recognized within the state(s) in which you practice).
Some nutritionists who start taking health insurance have reported that their practices have grown tremendously since making that decision. This is because clients who are seeking a nutritionist’s services usually consult their health insurance provider’s directory of in-network providers before choosing a nutritionist.
Accepting health care insurance also makes a nutritionist’s services more accessible to clients who could otherwise not afford these services. With more insurance plans covering a certain number of preventive nutrition counseling sessions per year, some nutritionists say that accepting health insurance is a no-brainer. It increases their client base, and, in turn, the revenue that they generate.
Other nutritionists lament the red tape involved in accepting health insurance. Nutritionists who decide to accept health insurance must legally register their practice and obtain a National Provider Identifier (NPI) number. They must then establish a system to process insurance billing. The process of setting up these things can be time-consuming.
Once a nutritionist’s health insurance billing system has been established, the hassles may continue. Claim forms must be filed correctly or they will be rejected and need to be re-filed, taking up more time and delaying reimbursement for services. Also, some insurance companies will not reimburse nutritionists at a high rate, leaving clients to pay the remainder of the charges, affecting how much a nutritionist is able to realistically charge for services.
Becoming Credentialed to Accept Health Insurance
If a nutritionist decides to forge ahead with the decision to accept health insurance, they should register with the Council for Affordable Quality Healthcare (CAQH). This registration is important, as it is a central hub which all health care insurance providers consult to verify a nutritionist’s certifications, registrations and credentials. Instead of you, as a nutritionist, having to supply your liability insurance, malpractice insurance, work history, experience, and specializations to each health care insurance provider, registering once with CAQH will enable you to become part of their network. CAQH then sends your information to insurance providers with whom you wish to participate. You still must contact and contract with each health insurance provider with whom you wish to participate on your own, however. Contracting with health insurance providers involves setting your fees, and the amount for which they will reimburse you.
What About Liability Insurance? Do I Need it as a Nutritionist?
Liability insurance covers health care professionals in the case of malpractice. If you are going to accept health insurance, you will need liability insurance. If a client sues you, this insurance will cover you to a certain degree, limiting the amount that you will have to pay. You must carry liability insurance in every state in which you practice as a nutritionist. Even if you are not going to accept health insurance from clients, having liability insurance is a must in order to protect yourself.