Fees $160 / Hour
Payment Due At Time of Service.
Payment by cash, check, debit or credit cards.
INSURANCE
Some Insurances Cover Nutrition Services.
OBAMACARE: “Nondiscrimination in Health Care” Clause:
Section 2706(a) of the Affordable Care Act states that insurers offering group or individual health plans "shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable state law.” The statutory language of Section 2706(a) is self-implementing and HHS does not expect to issue regulations in the near future. Section 2706(a) is applicable to non-grandfathered insurers offering group or individual health coverage beginning January 1, 2014.
OUT OF NETWORK COVERAGE: For office visits.
We are covered under PPO and POS Plans. No coverage for HMOs or EPO's.
CONDITIONS COVERED: These include: obesity, eating disorders, malnutrition, digestive problems, metabolic disorders, endocrine hormone imbalances, diabetes, heart disease, hypertension, kidney disease, cancer, food allergies and intolerances, autism and ADHD.
SUPERBILL PACKET: We provide: (1) a Claim form for your insurer; (2) a Superbill with codes; (3) code sheet for Medical Nutrition Therapy; (4) a copy of the Affordable Care Act's Nondiscrimination clause (if needed); (5) and the Virginia insurance law covering autism and ADHD (if needed).
SUPPLEMENTS: Are NOT covered by insurance.
INSURANCE COVERAGE - LAB TESTING
Most lab tests are billed directly by the lab to your insurance company. HMO and EPO cover Lab Corp and/or Quest Diagnostics Labs. Only PPO, POS and HSA plans, Medicare and Tricare cover specialty nutrition lab tests; and they may charge a co-pay. A small fee is charged by the Clinic for specialty lab kits and Hair tests.
INSURANCE COVERAGE - TRI CARE (Military)
TriCare does NOT have a category for "Nutritionists", and does not cover nutrition services. They will cover most labs.
INSURANCE COVERAGE - MEDICARE
Under Medicare law: "Medicare may cover Medical Nutrition Therapy and certain related services if you have diabetes or kidney disease, or you have had a kidney transplant within 36 months, and your doctor or other health care provider refers you for the service." Our office participates in out-of-network only.
INSURANCE COVERAGE – MEDICAID
Virginia Medicaid does not have a category for “Nutritionists”, and does not cover nutrition services. We do not participate with Maryland or DC Medicaid.
AUTISM LAWS IN YOUR STATE
National Conference of State Legislatures: See Autism legislation for your state.
VIRGINIA INSURANCE LAWS -- AUTISM
Virginia Code Ann. § 38.2-3412.1:01 The 2006 Virginia insurance law mandates coverage of "biologically based mental illness," which specifically includes autism and ADHD. It applies to children and adults, and both PPO and HMO plans. Therefore, these conditions are being covered. HMO will cover us only if they have no in-network nutritionists with Dr. Power's specialty. To read the law, See Articles. Under the Virginia 2011 law: insurance must also cover: Diagnosis, assessments, evaluations, neuropsychological evaluations, and genetic testing. Coverage also includes rehabilitative care: professional counseling, guidance, services, ABA, pharmacy care, psychiatric care, psychological care, speech therapy, occupational therapy, physical therapy, and social workers services. Limit of $35,000 for Ages 2-6. This law has been expanded.
MARYLAND INSURANCE LAWS -- AUTISM
Md. Insurance Code Ann. § 15-835. Requires insurers (PPO's), nonprofit health service plans and health maintenance organizations (HMO's) to provide coverage of habilitative services for children less than 19 years of age. Habilitative services include occupational, physical and speech therapy for the treatment of a child with a congenital or genetic birth defect to enhance the child's ability to function. This definition includes autism spectrum disorder.
DISTRICT OF COLUMBIA INSURANCE LAWS -- AUTISM
D.C. Code Ann. § 31-3271 and § 31-3272. Defines habilitative services as occupational, physical and speech therapy for the treatment of a child with a congenital or genetic birth defect to enhance the child's ability to function. This definition includes autism or an autism spectrum disorder. Requires health insurers to provide habilitative services for children less than 21 years of age. The coverage shall not be more restrictive than coverage provided for any other illness, condition or disorder. A health insurer shall not be required to provide reimbursement for habilitative services delivered through early intervention or school services.
Section 2706(a) of the Affordable Care Act states that insurers offering group or individual health plans "shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable state law.” The statutory language of Section 2706(a) is self-implementing and HHS does not expect to issue regulations in the near future. Section 2706(a) is applicable to non-grandfathered insurers offering group or individual health coverage beginning January 1, 2014.
OUT OF NETWORK COVERAGE: For office visits.
We are covered under PPO and POS Plans. No coverage for HMOs or EPO's.
CONDITIONS COVERED: These include: obesity, eating disorders, malnutrition, digestive problems, metabolic disorders, endocrine hormone imbalances, diabetes, heart disease, hypertension, kidney disease, cancer, food allergies and intolerances, autism and ADHD.
SUPERBILL PACKET: We provide: (1) a Claim form for your insurer; (2) a Superbill with codes; (3) code sheet for Medical Nutrition Therapy; (4) a copy of the Affordable Care Act's Nondiscrimination clause (if needed); (5) and the Virginia insurance law covering autism and ADHD (if needed).
SUPPLEMENTS: Are NOT covered by insurance.
INSURANCE COVERAGE - LAB TESTING
Most lab tests are billed directly by the lab to your insurance company. HMO and EPO cover Lab Corp and/or Quest Diagnostics Labs. Only PPO, POS and HSA plans, Medicare and Tricare cover specialty nutrition lab tests; and they may charge a co-pay. A small fee is charged by the Clinic for specialty lab kits and Hair tests.
INSURANCE COVERAGE - TRI CARE (Military)
TriCare does NOT have a category for "Nutritionists", and does not cover nutrition services. They will cover most labs.
INSURANCE COVERAGE - MEDICARE
Under Medicare law: "Medicare may cover Medical Nutrition Therapy and certain related services if you have diabetes or kidney disease, or you have had a kidney transplant within 36 months, and your doctor or other health care provider refers you for the service." Our office participates in out-of-network only.
INSURANCE COVERAGE – MEDICAID
Virginia Medicaid does not have a category for “Nutritionists”, and does not cover nutrition services. We do not participate with Maryland or DC Medicaid.
AUTISM LAWS IN YOUR STATE
National Conference of State Legislatures: See Autism legislation for your state.
VIRGINIA INSURANCE LAWS -- AUTISM
Virginia Code Ann. § 38.2-3412.1:01 The 2006 Virginia insurance law mandates coverage of "biologically based mental illness," which specifically includes autism and ADHD. It applies to children and adults, and both PPO and HMO plans. Therefore, these conditions are being covered. HMO will cover us only if they have no in-network nutritionists with Dr. Power's specialty. To read the law, See Articles. Under the Virginia 2011 law: insurance must also cover: Diagnosis, assessments, evaluations, neuropsychological evaluations, and genetic testing. Coverage also includes rehabilitative care: professional counseling, guidance, services, ABA, pharmacy care, psychiatric care, psychological care, speech therapy, occupational therapy, physical therapy, and social workers services. Limit of $35,000 for Ages 2-6. This law has been expanded.
MARYLAND INSURANCE LAWS -- AUTISM
Md. Insurance Code Ann. § 15-835. Requires insurers (PPO's), nonprofit health service plans and health maintenance organizations (HMO's) to provide coverage of habilitative services for children less than 19 years of age. Habilitative services include occupational, physical and speech therapy for the treatment of a child with a congenital or genetic birth defect to enhance the child's ability to function. This definition includes autism spectrum disorder.
DISTRICT OF COLUMBIA INSURANCE LAWS -- AUTISM
D.C. Code Ann. § 31-3271 and § 31-3272. Defines habilitative services as occupational, physical and speech therapy for the treatment of a child with a congenital or genetic birth defect to enhance the child's ability to function. This definition includes autism or an autism spectrum disorder. Requires health insurers to provide habilitative services for children less than 21 years of age. The coverage shall not be more restrictive than coverage provided for any other illness, condition or disorder. A health insurer shall not be required to provide reimbursement for habilitative services delivered through early intervention or school services.
Allergy & Nutrition Clinic
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Tel. 703-538-4161
Fax. 703-538-4239 Clinic@LauraPower.com |
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