5 Expert Tips to Get the Most Out of Your Health Insurance
- James Marin and Dahlia Marin
- Dec 1, 2025
- 7 min read
What you will learn:
How to double-check your benefits for FREE
When and how to use a Superbill for out-of-network reimbursement—and what must be on it
How to negotiate with your health insurance
How to pick the right health insurance plan
How to communicate with your provider and insurer to avoid surprises and speed up reimbursement
If dealing with your health insurance brings a gut wrenching sense of dread, stress, and can almost add to your chronic symptoms, then know that you are not alone! Studies actually show that over 50% of Americans do not fully understand their health insurance benefits and over 60% have had issues with their benefits.
For many of you, traditional health insurance is necessary and yet for some of you, it may not be necessary. If you have no chronic health conditions then you might want to check out this article we wrote on Health Cost Sharing (HCS). For the rest of you, below we share 5 proven ways to navigate insurance with confidence—so you can invest in your health and keep your costs in check.
Key Terms in this Article:
Provider- Any health professional, dietitian, doctor, chiropractor, physical therapist)
Health Cost Sharing- A plan that allows a select group of individuals the ability to share the costs of healthcare.
Health Insurance- a contract that covers a portion of your healthcare costs in exchange for a regular payment called a premium.
Premiums- A monthly payment made to your insurance in exchange for coverage.
Deductible- A specific amount agreed upon by your insurance that you must pay out of pocket before insurance coverage is activated.
Benefits Double-Check (Do this before you book a visit!)
Did you know that even though a provider is labeled as out-of-network by your insurance company they could still be cover by your insurance? Even when a practice is in-network with some plans, your coverage depends on your policy details. This can all be very confusing and many times leave you with unexpected bills. This is why we encourage every patient to verify benefits directly with their insurer (phone number on the back of your insurance card). We also recommend all offices (like ours) doing a coverage double-check as a courtesy. Simply fill out our online registration form being sure to include your insurance details and our team will double check your insurance benefits completely FREE with no obligation to use our services.
The HUGE key when it comes to checking your benefits is asking the right questions! If you do not ask, most insurance companies will not tell you what you need to know. I know this sounds insane, but most of the time this is true.
Below are some of the main questions our billers ask insurance companies when double checking benefits. These questions are specifically for working with a Registered Dietitian, but you can customize them for any healthcare provider. You can also ask these questions when contacting your insurance company to ensure you get a full picture of your benefits.
Main Questions to Ask your Insurance Company:
“Do I have medical nutrition therapy (MNT) benefits to see a Registered Dietitian?”
“Which CPT codes are covered? (Try 97802, 97803)”
“Do I need a referral or prior authorization?”
“What is my copay/coinsurance and deductible status right now?”
“Are visits covered for my diagnoses (e.g., IBS, IBD, SIBO, diabetes, CKD)?”
“Are telehealth visits covered? Any state restrictions?”
“Do I have out-of-network (OON) benefits for dietitians?”
Pro Tip: Know your deductible. If it’s high, you’ll pay out-of-pocket until it’s met; all qualified visits (RD, PCP, specialists) can contribute to meeting it. This is where using a HSA or FSA plan can save you LOTS of MONEY!
Medicare Note: Part B covers MNT for diabetes, CKD, and post-transplant only; for telehealth, Medicare pays only when you’re at an eligible originating site (not home) — prediabetes isn’t covered
2. Use a Superbill
What is a Superbill?—an itemized medical receipt with diagnosis and procedure codes that you submit to your insurer for potential reimbursement. We provide this document to all of our patients in their portal for every visit. Typically a Superbill is used if your dietitian/provider doesn’t bill your plan and you can use a Superbill to submit to your insurance for potential reimbursement. It’s not a guarantee, but many patients receive partial refunds if they have that option in their insurance plan.
What a Superbill includes:
your name/DOB, provider name/credentials/NPI, date & length of visit
CPT code(s) for nutrition counseling (e.g., 97802/97803)
ICD-10 diagnosis code(s) supporting medical necessity
fees paid (shows patient payment so the plan can reimburse you)
3. Negotiate with your Health Insurance (You have more leverage than you think)
If coverage is limited or your deductible is sky-high, ask about options:
Single-Case Agreement (SCA):
Your insurer may approve temporary in-network rates with a specific provider if access is limited or care is specialized. Basically, if you really need the care and there are limited providers due to location, expertise, or overall access, your insurance may grant you coverage.
Appeals:
If your claim for a visit is denied, you can appeal— especially when your clinician documents medical necessity and other important factors. Do not give up just because your insurance says no.
Care bundles/packages:
Many private practices offer multi-visit packages at a reduced per-visit rate. This is for people who opt for very basic insurance or just pay out of pocket. For example, our practice offers follow up visit packages that save at least 5% off of visits which adds up over time.
Payment plans/HSA or FSA:
A Health Share Account (HSA) or a Flexible Spending Account (FSA) are other tools that allow you to set aside tax free money for all health related expenses. Many medically necessary services, supplements, and labs may be FSA/HSA-eligible— confirm with your plan.
Remember: providers are experts in care, not in your specific policy. Insurance literacy ultimately sits with the member (you).
4. Pick the Right Plan (Open Enrollment Strategy)
California, New Jersey, Massachusetts, Rhode Island, and Washington D.C. require residents to have health insurance or face a state tax penalty, unless they qualify for an exemption. All of the options below help you avoid this penalty and even if you are living in a state that does not have this penalty, you still want to be covered in an emergency or for day to day needs.
During open enrollment, choose a plan that matches how you actually use healthcare:
Do you require a lot of visits, medications, and support? (Traditional Insurance) :
Plans with good out-of-network benefits or strong in-network coverage may save you more than a low premium alone. If you have high healthcare costs, paying a high monthly premium may be worth it since it will be much less than what you would pay out of pocket. The goal here is to work on getting healthier! If you are healthier you do not need as much coverage and can eventually reduce your health insurance to an option below!
Maybe You do not need much coverage, but still need something (Mix and Match):
Compare higher monthly premiums + lower deductibles vs. lower monthly premiums but higher deductibles (which means more out of pocket costs). If you or people in your family need healthcare support, but it is not life or death, you can have a hybrid method of having insurance with a higher deductible and using an FSA/HSA plan along with your health insurance.
Are you Very Healthy? Consider a Health Cost Sharing Plan:
If you and your family are healthy and you have done that math to show that paying for your health related costs out of pocket is way less than paying a monthly insurance premium, then this can be right for you. We have used Christian Healthcare Ministries (CHM) for 10 years and they have saved us tens of thousands of dollars. CHM is not insurance; they’re faith-based cost-sharing programs with typically lower monthly costs. They can work for very healthy, low-utilization folks willing to pay cash up front and submit bills.
Remember: If you do go with traditional insurance check the network carefully. If you are looking for more integrative care and already have someone in mind, ensure they are in your insurance network. This is where you might want to choose a PPO vs an HMO. Some plans exclude specific groups (e.g., certain carriers).
5. Communicate with Your Provider
Insurance often communicates with you before they notify us or your provider. If you get letters, portal messages, or EOBs (Explanation of Benefits), share them with your provider/dietitian’s office right away. This helps us code, document, and support you better and faster. What this means is that you meet your deductible faster, your provider gets paid faster, and you can expedite your care.
Bottom Line
You deserve the care and clarity to thrive and your health insurance should not stand in the way of that, which is why we do a complementary benefits double check for you before you even make an appointment. We recommend you learn your insurance plan, use Superbills strategically, negotiate when needed, pick a plan that fits your health goals, and keep your providers in the loop. We’re here to support you every step of the way so you can Heal with Each Meal™.
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References
Academy of Nutrition and Dietetics. (n.d.). What is a superbill? EatRightPRO. https://www.eatrightpro.org/career/payment/coding-and-billing/what-is-a-superbill
Centers for Medicare & Medicaid Services. (n.d.). National Coverage Determination (NCD) for Medical Nutrition Therapy (180.1). https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=252
Academy of Nutrition and Dietetics. (n.d.). Coding and billing. EatRightPRO. https://www.eatrightpro.org/career/payment/coding-and-billing
kffisabellev. (2023, June 15). KFF Survey of Consumer Experiences with Health Insurance |KFF. KFF.https://www.kff.org/affordable-care-act/kff-survey-of-consumer-experiences-with-health-insurance/
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