Getting a Food Guru

A dietitian's advice can free you from prescription meds.

From the WebMD Archives

When Susan Bilyeu was diagnosed with diabetes three years ago, her doctor?s advice seemed more like an ultimatum: Lose weight and change your eating habits or take blood sugar-lowering medication for life. Since she didn?t want to take the drugs, Bilyeu, who was 43 at the time, decided that it was time to overhaul her diet and shed some pounds. That, of course, is easier said than done. So Bilyeu decided to sign up with a personal nutrition coach -- a dietitian -- who would help her get her eating habits back on track.

How to Get Insurance Coverage for Dietary Counseling

First, the irony: While most health insurance policies cover the costs of surgery and other treatments for chronic diseases, many companies won't pay for the nutrition counseling that could help prevent the need for such costly interventions in the first place.

Now, the good news: More and more insurers are recognizing the value of one-on-one advice from a registered dietitian. If your doctor has recommended that you see a dietitian and your insurance won't cover it, here's what you can do:

  • File a claim anyway. If your insurer says your policy doesn't cover dietary counseling, send in the paperwork and see what happens. Include your physician's "prescription" -- the doctor's written referral to a dietitian. If the counseling is your idea, ask your doctor for a referral. Also include a letter, signed by both your dietitian and your doctor, detailing the medical need for your treatment.
  • Don't talk with the claims adjuster. These people typically look only at existing guidelines to decide what is or isn't covered. Instead, "ask your dietitian to talk to the medical director of the health plan," to consider covering nutritional counseling, says Michele Mathieu, Director of Health Care Financing at the American Dietetic Association.
  • Talk the talk. In letters or conversations, refer to dietitian visits as "medical nutrition therapy" or nutrition "management" or "treatment." "Insurers might not view 'nutrition education' or 'counseling' as medically necessary services," says Mathieu. By transforming these into medical "interventions" they may appear to be more necessary.
  • Emphasize the bottom line. Be sure to have your doctor and dietitian spell out the progress you are making and how much money is being saved as a result. If you've lost 20 pounds and cut the dose of drugs needed to keep your blood pressure in check, say so. Add up exactly how much that means in saved costs, and keep good records. Some companies "are demanding to see outcomes of dietitian visits" before they'll start covering them, says Mathieu. They might start authorizing them "if progress is being made."
  • Keep trying. Even if your claims are rejected, keep submitting new ones each time you see a dietitian, particularly if you are getting better. "Don't ever give up," Mathieu says, because if you are persistent about getting coverage, more often than not "it will happen." At the very least, each claim you file educates the insurer about the value of nutrition therapy and casts a vote in favor of covering it.


Cost and Effect

Luckily for Bilyeu, her insurance company covered the cost. Most insurers don't. And with visits to a dietitian costing anywhere from $50 to $125 an hour, many people who might benefit from such counseling hesitate to shell out for it.

A landmark report by the National Academy of Sciences' Institute of Medicine (IOM) concludes that getting nutritional therapy is often well worth the cost. Released in December, the report cites evidence showing that dietitians can help people -- both old and young -- to manage conditions such as high blood pressure, diabetes, high cholesterol, and heart and kidney problems. For example, a study by the Department of Veterans Affairs Medical Center in Long Beach, Calif., showed that more than half the people who saw a dietitian just three or four times reduced their cholesterol so much that they didn't need cholesterol-lowering medication. What?s more, the nutrition therapy saved the health care system about $60,000 per year in prescription drug costs.

On a national level, according to the IOM report, such savings can translate into millions. If Medicare beneficiaries with high blood pressure received nutrition therapy, health care costs over a five-year period could be cut by an estimated $52 million to $167 million for hypertension alone. Findings like this led the IOM report?s authors to conclude that Medicare should cover physician-ordered nutrition counseling.

A Tailor-Made Plan

At the root of a dietitian's effectiveness is the personal attention he or she can give. Nutritional counseling provides people with an eating plan designed around their own particular likes and dislikes, making it more likely they'll stick to it.

Dietitians start by learning what their client typically eats and then suggest small changes he or she can live with. That approach is vital because most people find it hard to stick to drastic dietary changes for the long haul. Dietitians also carefully review the client's medical history, looking for any medications that might be affected by certain foods or eating patterns, and any problems with swallowing, nutrition, or digestion.

Bilyeu kept a food diary for two weeks, "so we could pinpoint where I needed to tweak my diet," she says. Most dietitians use food diaries because they help people tune in to what they're eating, how much they're eating, and even the emotions or other cues that prompted them to reach for food. "It's an awareness-raising activity," says registered dietitian Cindy Moore, director of nutrition therapy at the Cleveland Clinic Foundation and a spokesperson for the American Dietetic Association.


Many people who try nutrition therapy notice a change in their condition within a few weeks. And some find that they only need two or three visits.

Under her dietitian's guidance, Susan Bilyeu lost 20 pounds, began exercising regularly, and brought her blood sugar under control -- without expensive medications.

These days, she checks in with her dietitian periodically for follow-up guidance. During Bilyeu's latest visit, for instance, her dietitian helped her decide what to serve at an upcoming party. "Seeing my dietitian regularly allows me to ask questions and make sure I'm on track," she says. "If I have a question, I can call her anytime."

Finding a Good Dietitian

If you're trying to find a credible professional to give you nutritional advice, don't start by looking up "nutritionist" in the phone book. A 32-state survey sponsored by the National Council Against Health Fraud in 1994 found that fewer than half the people listed that way in the Yellow Pages had legitimate training in the field of nutrition. Many held bogus degrees or gave out false information. No federal guidelines exist for the use of the term, and legal definitions vary from state to state.

According to a recent report from the Institute of Medicine, your best source for reliable nutrition advice is a registered dietitian -- look for the credentials "RD" after the name. To earn this title, the person needs to have graduated from a four-year college program approved by the American Dietetic Association that includes course work in biochemistry, biology, and diet therapy; passed a national registration exam; completed on-the-job training; and kept their knowledge current through continuing education.

To find a registered dietitian near you, ask your doctor for a referral, or contact local hospitals, all of which employ dietitians on staff. You can also call the American Dietetic Association's nationwide Nutrition Network Referral Service at (800) 366-1655 (weekdays from 9 a.m. to 4 p.m., Central Standard Time) for names and phone numbers of registered dietitians in your area.

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