Utah's Path To Nutrition Coaching Insurance Coverage: Understanding The Legal Landscape

In the United States, health coaches need to look at insurance from two different directions. First, they need business insurance for their own health coaching business to be financially secure when working with clients. Second, their clients may have health insurance that accepts or reimburses their health coaching services.

Health coaches can get business insurance in the form of professional liability insurance, which is the most common type of insurance for health and nutrition coaches. This type of insurance protects personal assets in the event of a malpractice claim. It also covers costs related to investigations into license complaints.

Health coaches can also get individual liability policies, which may insure them for a higher amount and will usually remain in place if they change jobs. Some organisations even require employees to have their own personal liability insurance.

In terms of billing insurance, health coaches can follow these steps:

1. Make sure your certification is up to date.

2. Register for your National Provider Identifier (NPI).

3. Provide your client with the information they need.

Health coaches can also encourage clients to submit claims for reimbursement on their own if they have out-of-network coverage and provide them with documentation for billing in the form of a superbill.

CPT codes for health and well-being coaching

CPT codes are an important part of the health coaching industry, as they allow health coaches to submit claims to insurance companies for reimbursement. CPT stands for Current Procedural Terminology, and these codes are created by the American Medical Association (AMA). CPT codes are important because they offer a uniform language for coding medical services and procedures, which streamlines reporting and increases accuracy and efficiency.

There are three main categories of CPT codes:

• Category I codes are used for procedures and services.
• Category II codes are used for performance measurements.
• Category III codes are temporary codes assigned to new and developing technology, procedures, and services.

In 2019, the AMA approved the creation of new Category III CPT codes specifically for health and well-being coaching. These codes went into effect on January 1, 2020, and include:

• 0591T Health and Well-Being Coaching face-to-face; individual, initial assessment
• 0592T individual, follow-up session, at least 30 minutes
• 0593T group (two or more individuals), at least 30 minutes

It is important to note that reimbursement by payers of Category III codes is optional. Insurance payers typically wait until codes have Category I approval before providing reimbursement. However, the approval of these CPT codes for health and well-being coaching is still a major breakthrough for the industry. It signifies the acknowledgment of health and wellness coaching as a legitimate and necessary part of the healthcare system and allows for data collection and assessment of the efficacy and widespread use of health coaching.

To use these CPT codes, health coaches must be certified by either the National Board for Health and Wellness Coaching (NBHWC) or the National Commission for Health Education Credentialing (NCHEC). Additionally, health coaches need to obtain a National Provider Identifier (NPI), which is a unique 10-digit government-issued identification number for healthcare providers. While payment from insurance companies using these CPT codes is optional, having an NPI number will streamline the process of submitting claims if reimbursement becomes more widely available in the future.

Getting certified as a health coach

To become a certified health coach, you'll need to complete a training program that's approved by the National Board for Health and Wellness Coaching (NBHWC). The NBHWC is the national standard for Health and Wellness Coaching.

The NBHWC requires you to complete an approved 75-hour training program, followed by a 50-hour coaching session requirement. Once you've completed the coaching sessions, you can take the national exam, which is regulated by the National Board of Medical Examiners (NBME) and the International Consortium for Health and Wellness Coaching (ICHWC).

There are a variety of training programs available, including online courses and in-person workshops. Some programs offer flexible learning, allowing you to complete the course at your own pace, while others have a more structured timeline. The cost of certification programs varies, but generally, they range from $1,500 to $30,000.

It's important to note that anyone can call themselves a "health coach", but certification is crucial to establish credibility and ensure proper training. Becoming certified also opens up more employment opportunities.

In addition to completing a training program and passing the national exam, some organizations may require additional credentials, such as a minimum level of education or work experience. It's essential to check the specific requirements of the organization you're interested in joining.

Once you've obtained your certification, you may also want to consider getting business insurance for your health coaching business and registering for your National Provider Identifier (NPI) number, which is required for billing insurance.

Registering for an NPI number

The National Provider Identifier (NPI) is a 10-digit number that is used to identify healthcare providers in standard transactions, such as healthcare claims. It is required for all healthcare providers who are HIPAA-covered entities and those who bill Medicare for their services. The NPI is free and does not expire or change.

To register for an NPI number, you can apply in one of three ways: online, by mail, or through a designated CMS contractor. The online application is generally the fastest and easiest option and can be completed through the National Plan and Provider Enumeration System (NPPES) website. You will need to provide the following information:

• Reason for submitting the application
• Identifying information, including name, SSN and/or ITIN
• Name of your organization, including EIN
• Mailing and practice location addresses
• Other provider identification numbers, if applicable
• 10-digit provider taxonomy code

If you choose to apply by mail, you will need to complete, sign, and mail a paper NPI Application/Update Form to the NPI Enumerator. The form can be obtained by contacting the NPI Enumerator by phone, email, or mail.

Alternatively, you can give permission to an Electronic File Interchange Organization (EFIO) to submit application data on your behalf through a bulk enumeration process. This option may be suitable for large organizations or groups of providers.

Understanding insurance reimbursement

Nutrition coaching can be a valuable service for individuals seeking to improve their health and well-being. In some cases, insurance providers may cover the cost of nutrition counselling, especially if it is deemed medically necessary or prescribed by a physician for specific conditions such as diabetes, obesity, or heart disease. However, it is important to note that insurance coverage for nutrition counselling can vary depending on the specific insurance plan, the state or country of residence, and other factors.

In the United States, the Affordable Care Act (ACA) has improved access to preventive services, including nutrition counselling, for individuals at risk for chronic diseases. Under the ACA, nutrition services are available to all adults at risk, regardless of their insurance type (Medicaid, Medicare, or private insurance). Additionally, the ACA requires that these services be provided with no copayment charged.

When it comes to insurance reimbursement for nutrition coaching, there are a few key steps and considerations to keep in mind:

• Credentialing and Contracting: To become an in-network provider with insurance companies, nutrition coaches need to go through the credentialing and contracting process. Credentialing involves obtaining necessary certifications, licenses, and registrations, such as an Employer Identification Number, a National Provider Identifier (NPI), and liability insurance. Contracting involves becoming an in-network provider with specific insurance companies, which will outline the policies and guidelines for filing claims.
• Understanding Fee Schedules: A fee schedule, or contract rates, is a list of fees used by insurance payers to reimburse wellness providers, including dietitians and nutrition coaches. Each insurance payer creates its own fee schedule, which may be provided during the contracting process or upon request. It is important to review the fee schedule to understand the reimbursement rates for specific services and procedures.
• Common Insurance Billing Codes: When billing insurance payers, it is essential to use the correct billing codes to indicate the services provided. Current Procedural Terminology (CPT) codes, set by the American Medical Association, are five-digit codes used to describe medical services and procedures. Healthcare Common Procedure Coding System (HCPCS) codes are used for billing Medicare and Medicaid patients and include codes specific to nutrition services, such as medical nutrition therapy and diabetes self-management training.
• Understanding Insurance Plan Coverage: Insurance coverage for nutrition coaching can vary depending on the plan. Some plans may offer out-of-network benefits, while others may require in-network providers. It is important to review the specific details of the insurance plan, including any referrals, prior authorizations, visit limitations, and out-of-pocket expenses such as deductibles, copayments, and coinsurance.
• Verifying Coverage and Provider Networks: To find nutrition coaches covered by insurance, individuals should review their insurance policy, contact their insurance provider, and search for in-network providers through online directories or recommendations from healthcare professionals. It is essential to verify the provider's credentials and confirm that they are currently in-network, as provider networks can change.
• Considering Alternative Options: If individuals cannot afford a nutrition coach or their insurance does not cover the service, there are alternative resources available, such as consulting with a primary care physician, utilizing online resources, attending community workshops, or seeking sliding-scale or income-based services.

By following these steps and considerations, nutrition coaches and individuals seeking their services can better understand insurance reimbursement and maximize their chances of receiving coverage for these valuable services.

The No Surprises Act

• Surprise bills are not allowed for covered emergency out-of-network services, including air ambulance services. A facility or provider may not bill more than your in-network coinsurance, copays, or deductibles for emergency services, even if the facility or provider is out-of-network.
• Surprise bills are not allowed for covered non-emergency services performed by an out-of-network provider at an in-network facility. An out-of-network provider may not bill more than your in-network copays, coinsurance, or deductibles for covered services performed at an in-network facility.
• Out-of-network charges and balance bills are banned for certain additional services (e.g. anesthesiology or radiology) furnished by out-of-network providers as part of a patient’s visit to an in-network facility.
• Health care providers and facilities must give patients an easy-to-understand notice explaining the applicable billing protections, who to contact if protections have been violated, and that patient consent is required to waive billing protections.

The Act also establishes an independent dispute resolution process for payment disputes between plans and providers and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.

If you don’t have health insurance or choose not to use your health insurance for a service, the No Surprises Act ensures that you will get a good faith estimate of how much your care will cost before you receive it. If you are billed for an amount more than $400 above the good faith estimate, you may be able to dispute the charges.

If you have coverage through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE, you are already protected against surprise medical bills from providers and facilities that participate in these programs.

Frequently asked questions