Menu
  • bcbs-logo2

Understanding Your Insurance Benefits

There are many insurance plans available today, and policies can vary greatly—even policies provided by the same insurance carrier.  Understanding your coverage will enable you to plan ahead and avoid unexpected costs. At LifeStyle Medical Center, our patient liaisons will make every effort to verify your coverage for services beforehand.

The Affordable Care Act

The Affordable Care Act has significantly increased the preventive services available at no cost to you.  To understand if this applies to your insurance plan, it is important to know whether your plan is considered grandfathered or non-grandfathered.  Simply put, if you have a plan that existed on or before March 23, 2010, it may be considered grandfathered, and therefore not subject to mandatory coverage of certain preventive services.  If you have a non-grandfathered health plan, most insurance plans are required to cover a comprehensive list of preventive services with in-network providers at NO COST TO YOU.

To learn more about grandfathered vs. non-grandfathered plans, visit the relevant HealthCare.gov website page.

To learn more about which preventive services are available to non-grandfathered plans without any copayments, coinsurance or deductibles, visit the relevant HealthCare.gov website page.

Many of the services you will receive at Lifestyle Medical Center are considered preventive services and not subject to copays, coinsurance, or deductibles for non-grandfathered plans.

Confirming Your Benefits

It is important that you understand your benefits. Patient liaisons at LifeStyle Medical Center will call your insurance company on your behalf, but many times an insurance carrier will not guarantee the information they provide to us. While we will make every effort to provide you with the most accurate information, please understand if charges are denied by the insurance company, you will be billed directly for the services.

Unique Approach to Fit Your Insurance Plan

LifeStyle Medical Center is not a traditional primary care practice, nor are we a dietitian practice. Our unique approach to lifestyle medicine allows us to cater our services to your insurance plan as much as possible. All of our providers are highly trained in lifestyle modification and medical nutrition therapy, and we will match these providers to your insurance benefits structure. If you are only allowed a certain number of visits (or none at all) to see a registered dietitian, we will adjust our care team accordingly to ensure you see a nurse practitioner/physician assistant for the majority of your visits.  If you have unlimited visits with no copay to see a registered dietitian, we will minimize your visits with nurse practitioners/physician assistants to help you avoid costly copays and deductibles as much as possible.

Blue Cross Blue Shield Benefits

At this time, LifeStyle Medical Center is in-network with Blue Cross Blue Shield of North Carolina, Blue Value, Aetna and Coventry (excluding Duke plans). We are currently working with other insurance carriers and Medicare to be added as an in-network provider and will continue to update this page as new information becomes available.  For those patients without a Blue Cross plan, we do offer very transparent self-pay pricing options. Additionally, at your request and on your behalf, we are happy to file as an out-of-network provider with other carriers.

Many of the Blue Cross and Blue Shield policies now cover medical nutrition therapy at 100% (no copay, no coinsurance, no deductible) as a part of your preventive care. Registered dietitians primarily provide these services; however, some plans do allow for nurse practitioners/physician assistants to provide these services.

Some non-grandfathered policies do have medical nutrition therapy coverage with a limited number of visits.  In these situations, we will develop care plans and teams that include more visits with our nurse practitioners/physician assistants.

Blue Cross and Blue Shield State Health Plan

Enhanced 80/20 plan
Your policy covers UNLIMITED visits to a registered dietitian with no out-of-pocket expenses. ($0 copay, $0 coinsurance, and $0 deductible).

Your visits with nurse practitioners/physician assistants are subject to primary care copays.

Standard 70/30 plan
Without Diabetes: Your policy covers 4 visits to a registered dietitian with a primary copay.
With Diabetes: Your policy covers 6 visits to a registered dietitian with no out-of-pocket expenses ($0 copay, $0 coinsurance, and $0 deductible).

Your visits with nurse practitioners/physician assistants are subject to primary care copays.

Blue Cross and Blue Shield Out-of-State-Plans

All out-of-state plans are unique in benefits. Many of the policies now cover medical nutrition therapy at 100% (no copay, no coinsurance, no deductible) as a part of your preventive care. Registered dietitians primarily provide these services; however, some plans do allow for nurse practitioners/physician assistants to provide these services. Our patient liaison will verify your plan and let you know the coverage you are eligible for.

Blue Cross and Blue Shield Federal

Both the Standard and Basic plans cover UNLIMITED visits to a registered dietitian with no out-of-pocket expenses ($0 copay, $0 coinsurance, $0 deductible).

Your visits with nurse practitioners/physician assistants are subject to primary care copays.

Aetna Benefits

Most plans offer up to 26 visits for obesity counseling and in most cases, no copay or deductible to see both nurse practitioners/physician assistants and registered dietitians.

Coventry Benefits

Most plans offer unlimited visits for obesity counseling and in most cases, no copay or deductible to see both nurse practitioners/physician assistants and registered dietitians.

Cigna Benefits

Coverage varies according to your plan, with some plans covering Registered Dietitian visits at a 100%, and others allowing limited number of visits. Most clinician visits may be subject to co-pay, but preventive visits may be fully covered. 

Duke Select/Duke Basic

Currently, we cannot accept Duke Select or Duke Basic plans. However, Duke employees with Blue Care and Duke Options (both BCBS administered) are considered in-network with LifeStyle providers. For Duke Select or Duke Basic patients, we do offer very transparent self-pay pricing options and will file as an out-of-network provider on your behalf and at your request.