Insurance
I am currently in network with Health Net and Blue Shield of California
Health Net
Blue Shield of California
Prior to scheduling, please call Blue Shield of California to check your benefits. This helps ensure you are clear on what your plan may cover. It is likely we will need a MNT referral from your physician or therapist with a diagnosis statement to be kept on file. I am happy to provide you with a MNT referral form if your provider does not have one.
HEALTH NET PPO PLANS
It’s likely that you do not need prior authorization to schedule with us. Please double check when you check your benefits with Health Net. You will still need a referral from your physician or therapist with a diagnosis to be kept on file.
HEALTH NET HMO PLANS
You will likely need a referral and prior authorization before scheduling with us. When you check your benefits, ask about whether your PCP needs to submit prior authorization to your medical group. It’s likely this is the case. Your physician will need information about our practice.
Please Note
In order to begin care, we will need a referral from your physician in order to get coverage. In order to avoid delay in services, please request an MNT referral from your physician. This can be faxed to me directly by your provider, or you can provide this information when we meet for our initial assessment.
Instructions For Checking In-Network Benefits
Business is: Caroline A Holbrook MS, RDN
EIN: 99-1453561
NPI Number: 1790470383
Call the phone number for customer services usually located on the back of your insurance card. You will need my business name, EIN number, and NPI number located above. You’ll want to request to speak with the benefits department and ask the following questions:
- Is Medical Nutrition Therapy (MNT) covered in-network benefit based on my plan? The procedure codes I use are: 97802 (initial assessment), 97803 (follow up), and on occasion S9470 (nutrition counseling code).
- Is coverage dependent on your diagnosis? If so, provide them with your nutrition-related diagnosis. If you do not have a nutrition-related diagnosis, you can request this from your doctor.
- Are there any benefits for "preventative Z codes" such as Z71.3? If so, you will want to ask which Z codes/codes are covered and what the requirements are.
- If there is an MNT benefit, ask if there are any restrictions (ex. limit on number of visits covered, having to use certain practitioners, etc).
- Ask if your benefits are subject to copay, deductible, coinsurance, out-of-pocket max, etc.
- If your insurance company says that MNT is a benefit, be sure to document the date, reference number, name of who you spoke with, and details from the call. If available, ask them to send you this information in writing.
Still Have Questions?
Send me an email with any questions you have and I will be happy to answer them!
I specialize in providing evidenced based eating disorder treatment, ARFID/selective eating support, intuitive eating coaching, and weight neutral diabetes care. Click below to learn more!
Disclaimer- This website is for informational and educational purposes only. This site is not a substitute for medical advice. You may not use this site without reviewing the Terms of Use and Privacy Policy.
© Copyright- Caroline A Holbrook MS, RDN 2024