Individualized nutritional evaluation and counseling for the management of any medical condition for which appropriate diet and eating habits are essential to the overall treatment program is covered when ordered by a provider and received through a licensed health care professional (e.g., a registered dietitian).
- PPO Plan members may receive up to 6 sessions covered at 100% annually with a licensed health care professional who is in the network or who practices at a network facility, without preauthorization.
- HSA Plan members may receive up to 6 sessions covered 100% annually with a licensed health care professional who is in the network or who practices at a network facility, without preauthorization, after the deductible is met.
For all plans, any sessions after 6 may be covered at 100%, upon preauthorization by the medical plan, if services continue to be medically necessary.
Conditions for which nutritional evaluation and counseling may be considered medically necessary include, but are not limited to, the following:
- Anorexia nervosa/bulimia
- Celiac disease
- Cardiovascular disease
- Crohn's disease (CD)
- Diabetes mellitus (DM)
- Disorders of metabolism (e.g., inborn errors of metabolism, inherited metabolic diseases, amino acid disorders)
- Liver disease
- Malabsorption syndrome
- Metabolic syndrome X
- Multiple or severe food allergies
- Nutritional deficiencies
- Post-bariatric surgery
- Renal failure
- Ulcerative colitis (UC)
Preauthorization by medical plan required after 6 sessions annually.