Insurance

We cannot guarantee payment by your insurance company for our services and we DO NOT check your insurance for coverage of our services.  Therefore, we have a number of resources to help you find out what the benefits are on your plan. We always recommend that patients call their health plan before being seen to ask about coverage and benefits. We also recommend you call when there are any changes in your plan (new plan year, change in coverage/plan, change in insurance company). A script is available to help guide that call and can be found here.  If you use this script we suggest you get a reference number and keep for your records. If insurance claims don’t pay the way you were quoted, the reference number can be a useful tool in getting the claim paid.

Insurances we accept:

Independent Health/Nova

We accept all lines of business with Independent Health/Nova. Usually covered in full for all plans if medically necessary. (see list of example diagnoses below) As of this date in person AND virtual visits are being covered.

An additional call to the company to check benefits is not usually necessary but certainly can be done if you wish.

EXAMPLE COVERED DIAGNOSES – NOT AN ALL INCLUSIVE LIST

Highmark BCBSWNY

All our clinicians take all lines of business with BCBS – when calling they may say your clinician is not in network and that is not correct. IF your plan has a deductible, we are seeing that the deductible does apply. Your plan also may have a copay for our services. The reason for treatment must be medically necessary. (see example conditions below) As of this date in person AND virtual visits are being covered. We strongly recommend you call Highmark BCBS and check coverage and get a reference number.

WE ARE NOT CURRENTLY TAKING ANY NEW PATIENTS FROM THE AMERIGROUP – BCBS MEDICAID LINE OF BUSINESS.  

BCBS OF MICHIGAN (IF THIS IS YOUR HOME PLAN) DOES NOT COVER FOR OUR SERVICES.

EXAMPLE COVERED DIAGNOSES – NOT AN ALL INCLUSIVE LIST

• Hyperpotassemia
• Hypopotassemia
• Hypertension complicating pregnancy, childbirth, and the puerperium Hypertensive disease
• Human immunodeficiency virus (HIV) disease
• Ischemic heart disease Liver diseases, cirrhosis, and other diseases of the digestive system
• Morbid obesity
• Myocarditis
• Myocardial degeneration
• Nutritional deficiencies Myocarditis
• Myocardial degeneration
• Obesity
• Osteoporosis
• Other specified disorders of metabolism
• Regional enteritis, ulcerative colitis, vascular insufficiency of intestine, other and unspecified noninfectious gastroenteritis and colitis, intestinal obstruction, diverticula of intestine, and functional digestive disorders
• Overweight
• Secondary diabetes mellitus
• Symptoms concerning nutrition, metabolism and development.

Univera

We accept all lines of business with Univera Healthcare. Usually there is coverage for our services, however- your deductible and copay may apply. The reason for treatment must be medically necessary (see example conditions below) As of this date in person AND virtual visits are being covered. (if you have a self-funded plan you will want to ask specifically about coverage for virtual visit – they may not be covered) We strongly recommend you call Univera and check coverage and get a reference number.

EXAMPLE COVERED DIAGNOSES – NOT AN ALL INCLUSIVE LIST

• Obesity, Eating disorders, diabetes (e.g., newly diagnosed diabetes, uncontrolled diabetes, gestational diabetes) or pre-diabetes; hyperlipidemia; metabolic syndrome (sometimes referred to as insulin resistance syndrome or syndrome X); severe vitamin or mineral deficiencies, Certain inborn errors of metabolism, including: branch-chain ketonuria; galactosemia; hereditary fructose intolerance; homocystinuria; phenylketonuria (PKU); and porphyrias.
• Malabsorption or storage disorders, including: amyloidosis (primary and secondary); celiac disease; chronic intestinal pseudo-obstruction (Ogilvie’s syndrome); gastroesophageal reflux (GERD); glycogen storage disorders, inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis); and lipid storage disorders Multiple or severe food allergies, Malnourishment or malnutrition of patients with a swallowing impairment or dysfunction who require nutritional guidance.
• Chronic renal insufficiency or failure
• Hypertension.

Cigna

We accept all lines of business with Cigna. The only clinicians that take this insurance are Allyson Odachowski, Krista Martens, Shannon Wilson and Wendy Scime. Usually there is coverage for 3 visits per year. Additional visits may be covered if medically appropriate under preventive coverage. As of this date in person AND virtual visits are being covered. We strongly recommend you call Cigna and check coverage and get a reference number.

United Healthcare and the Empire plan

We accept all lines of business with United Healthcare/Empire plan. Only certain clinicians participate with certain plans. Please be sure to ask if your clinician is in network. Coverage is going to depend on your plan and the reason you are being seen. As of this date in person AND virtual visits are being covered. We strongly recommend you call UHC and Empire plan to check coverage and get a reference number.

Medicare (including managed medicare plans through BCBS, Univera, UHC and Aetna)

Clinicians who participate with this plan include: Allyson Odachowski, Jessie Krempholtz, Shannon Wilson and Wendy Scime.

Coverage is limited to: Diabetes (all types) and Kidney disease (stage 3 or higher). A referral may be required, we will let you know if that is the case. In most cases coverage is limited to 2-3 hours a year but additional coverage can be requested if medically necessary. If this is the case we will work with your doctor to get the necessary documents.

At this time, in person AND virtual visits are being covered.

There is no need to call these plans about coverage because it is very specific.

Aetna

We accept all lines of business with Aetna. Coverage will depend on the reason you are being seen and your plan. In general there is usually coverage for the following conditions: BMI >25; hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome, diabetes mellitus, eating disorders, gastro-intestinal disorders, hypertension, kidney disease, seizures, and other conditions (e.g., chronic obstructive pulmonary disease).  At this time in person AND virtual visits are being covered. We strongly recommend you call Aetna and check coverage and get a reference number.

Molina Healthcare

We accept all lines of business with Molina. Coverage will depend on the reason you are being seen and your plan. At this time in person AND virtual visits are being covered. We strongly recommend you call Molina and check coverage and get a reference number.