New Patient Forms

Please complete the following forms for your appointment. Contact us with any questions.

Insurance Coverage

Whole Health Nutrition RDs are participating providers with several insurance companies.

  • United Health Care

  • Cigna

  • Medicare

  • Blue Cross Blue Shield of Vermont

  • MVP Healthcare

  • Green Mountain Care/VT Medicaid

Insurance can be confusing so here is a starting guide to insurance coverage for nutrition counseling.

We recommend you always verify your insurance coverage for nutrition counseling prior to your appointment. You will be asked which CPT codes will be used. Initial appointments are 97802 & follow up appointments are 97803.

Some questions to ask you carrier include the following:

  • Do I have coverage for nutrition counseling for preventative coverage? The code we use is z71.3. If the answer is no, ask if a diagnostic code is required. You can reach out to your clinician to know which code they will be using.

  • How many sessions will be covered?

  • Is a referral required for sessions to be covered?

  • Will these sessions apply to my deductible or is there a copay? If yes, how much is remaining on my deductible or how much is my copay. 

BCBS, Cigna, MVP, United Health Care: Most commercial plans including Blue Cross Blue Shield of VT, Cigna, MVP, United Health Care cover 3 sessions per year.  This coverage depends on deductibles, and each plan often varies according to the plan’s home state.

Vermont Medicaid/Green Mountain Care: Provides full coverage for nutrition counseling.

Medicare: will only cover nutrition counseling for Diabetes or Renal Disease, all other conditions will not be covered. There is limited coverage for secondary insurance. Please call your insurance companies to verify coverage prior to your appointment. All patients with Medicare will need a referral prior to receiving services.

Medicare/Medicaid: Medicare primary with Medicaid Secondary only is covered for individuals with Diabetes or Renal Disease, all other conditions will not be covered. All patients with Medicare/Medicaid will need a referral prior to receiving services.  

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of items and services based on your treatment needs. While it is not possible for the dietitian to know, in advance, how many sessions may be necessary and appropriate for a given person, this document provides an estimate of the cost of services provided. Your total cost of services will depend upon the number and length of sessions you attend, as well as your individual circumstances.

Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item.

You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.