Discussing Coverage with Clients in the New Year

The new year is just around the corner! As such, your clients may come to you with questions about their coverage for the remainder of the calendar year and heading into the new year, since many insurance plans will “re-set” come January 1st. How do you know how many nutrition counseling appointments your client is allotted for the remainder of this year? And what does coverage look like come January 1st – has anything changed?

Steps to Take Heading Into the New Year

Get a jump on understanding what is available to your client in terms of nutrition counseling appointments. As a first step, confirm plan information with your client, as their plan membership details may have changed (i.e. Member ID, mailing address, etc.) Then, you may wish to conduct an eligibility estimate in the new year to find out what your client is eligible for, or whether your client’s coverage has changed in any way. As an estimate is not a guarantee of coverage, you may instead opt to wait for an Explanation of Benefits (EOB) and then collect the appropriate payment from your client, or collect the specialist copay amount upfront and then reimburse your client as needed. Note that insurance plans don’t provide updated benefits before January 1st and some may take a few weeks in January to “re-set” plans with updated allowances.

Health Savings Accounts, Flexible Spending Accounts, and Health Reimbursement Arrangements

Your client may also wish to “use up” remaining available insurance benefits this calendar year by meeting with you for a nutrition counseling session. If he/she has a Health Savings Account (HSA), Flexible Spending Account (FSA) or Health Reimbursement Arrangement (HRA), here is what you need to know.

If your client has an HSA, which acts like a personal bank account for health expenses, they need not worry about using up any unused benefits, as any unused money carries over to the next year. FSAs are similar to HSAs in that they help cover qualifying medical charges. If your client has an FSA, note that unused money is not carried over at the end of the year; encourage your client to schedule another appointment (or two!) with you prior to the close of the calendar year. HRAs are employer-owned; your client’s employer determines whether your client can carryover unused money. Encourage your client to find out whether any funds remain for your services if they have an HRA.

These accounts can indirectly help pay for nutrition counseling sessions by covering your clients’ deductibles or co-pays, after which insurance kicks in. When you have patients who use HSAs, FSAs and HRAs this way, you will still need to file claims for the insurance portion.

Your Healthy Bytes billing allies are here to help you figure out what nutrition counseling benefits will look like for your clients in the new year. Reach out to us so that you can take advantage of marketing your services next calendar year!