Today I wanted to chat about the credentialing state nuances registered dietitians may experience during the insurance credentialing process.
In my tenure as a reimbursement coach to many ah-mazing ROCK-RDs, I have had the privilege of working with RDs in every single US state. Therefore, while I know reimbursement in CT like the back of my hand, I am no stranger to the reimbursement process in all states.
When it comes to credentialing certain states are easy-peasy. While other states will give RDs a run for their money. I really want you to know as much as possible before you jump into my coaching program. So please read the following carefully. I have done my best to outline any specific nuances I am aware of with certain states.
Closed Networks – what does it mean
When I refer to an insurance network being ‘closed’ it means the insurance company is implying that there are already enough dietitians in that particular zip code. Most of the time that is complete bullshit. I teach you how to appeal to closed networks in my program. And MANY RDs are super successful after taking my advice and following my writing samples for appeals. The only network I have NOT seen an RD penetrate are Empire BCBS in NY, Florida Blue, and Michigan BCBS. I talk more about those below.
States which make it a wee bit more difficult to credential
Florida – I have written extensively about the issues with credentialing in Florida. You can read about what I know HERE. Unfortunately, no networks aside from Medicare are open for RDs located in Florida.
In some zip codes, Aetna is open but it is not a traditional Aetna plan. It is a discount plan and only pays a flat rate per visit I believe it is $65/visit for an initial visit. And $50 for a follow-up visit. These visits don’t have a time frame attached to them. Meaning it could be a 15-minute initial visit or a 60-minute initial visit. You are paid per visit independent of how long you spend with the client. This is super atypical. Just for reference, my Aetna coverage in CT pays >$160/hour.
In some zip codes, you can credential with Oscar which is a small insurance plan with modest coverage. Also, certain Medicaid plans may be open. However, the status of those plans changes frequently. So that is why I am identifying them.
Michigan – Similar to Florida. I have written extensively about the issues with credentialing in Michigan. You can read about what I know HERE. Unfortunately, very few networks aside from Medicare are open for RDs located in Michigan.
While participating with Medicare can be advantageous depending on the population in which you serve, most Medicare plans are what we call Advantage plans. They are a Medicare plan managed by a commercial carrier. For example, the United Health Care Medicare Advantage plan. You need to be in with BOTH United Health Care and Medicare. Therefore, getting credentialed with Medicare can still be very limiting as you can’t service patients with Medicare Advantage plans.
Some RDs have reported being able to get into Aetna and United Health Care. While other RDs have told this is not possible.
North Carolina – There are certain areas of NC that are closed to accepting new United Health Care providers. But I have seen many RDs successfully appeal and get in network. In addition, while your BCBS product pays very well, it takes a LONG time for them to complete the credentialing process. I would say I am seeing it take on average about 7 months. That should not STOP you. But my words of wisdom are to get your application in NOW and worry about the details later.
South Carolina – Most plans in SC DO cover nutrition, but getting access to bill them is the key issue. You can only bill if you file through a contract from a different state. However, the huge glaring issue is that the SC State plan (PEBA) for state employees has a specific exclusion for nutrition coverage and it covers a LOT (>100k) of members. I will add that nearly all marketplace plans in SC cover unlimited nutrition visits and these cover a growing percentage of people.
New York – So if you are in the Manhattan and Westchester areas of NY you may find certain insurance networks are closed. The insurance companies credential by zip code. Currently (2023) the Empire BCBS network is closed. Emblem GHI is also closed. Certain zip codes in NY United Health Care appears closed as well. If you are in Northern or Western NY most of the insurance networks are open including BCBS.
California – ALL patients seen in CA regardless of whether or not they are cash-pay or insurance require an MD referral. This is based on your licensure laws.
Alabama – ALL patients seen in AL regardless of whether or not they are cash-pay or insurance require an MD referral. This is based on your licensure laws.
Tennessee – ALL patients seen in TN regardless of whether or not they are cash-pay or insurance require an MD referral. This is based on your licensure laws.
Iowa – The majority of your networks are open. But your BCBS product (Wellmark) doesn’t credential dietitians in-network. Therefore, you can apply to be an out-of-network provider with Wellmark. You will get paid. But it is a little wonky as the money goes directly to the patient for the services. But RD MNT services are covered.
Colorado – In certain zip codes, Aetna and United Health Care may be closed to new providers. Your BCBS product is a discount plan. And not a ‘normal’ plan. This means it pays per visit (not per 15-minute increments like most plans) independent of the time you spend with the client. I have been told that the best zip code for open networks is those located within the Denver area. Many RDs in CO have appealed to the closed networks successfully and have gotten in.
Well, that is all I have for you today. I really believe that knowledge is power when it comes to running a successful private practice. So I am hoping you find this information helpful. If you are an RD in a state where I might have missed the nuances, hit up below and the comments. I really think the more we can share about insurance the less freaky accepting it may seem.
Cheers to kicking butt and taking names.