Insurance For Private Practice Dietitians: The Pros and Cons of Accepting Insurance
Are you a private practice dietitian wondering if it’s worth it to accept insurance in your practice?
We support insurance-based dietitians and private pay dietitians in Business School. We’ve helped insurance-based dietitians get off of insurance panels, as well as private pay dietitians get on insurance panels! There is no “right” or “wrong” with this topic!
This blog will explain the pros and cons of accepting insurance, as well as the pros and cons of NOT accepting insurance. All of this information will help you make a decision that’s right for your practice!
Make sure to download The Ultimate Checklist To Start Your Private Practice. This resource is for beginners who want to know the steps to take to start a business!
Advantages of Insurance for Private Practice Dietitians
There are many benefits to accepting insurance as a private practice dietitian.
Some of the advantages are:
- Usually increased # of clients: You usually have more clients because clients can use their insurance benefits for covered visits.
- Less financial stress for your clients: Clients might not have to worry about extra session costs when they use their insurance.
- Clients may engage in treatment longer: The longer a client stays with you, the more time you have to help them reach their goals.
- Free advertising: Insurance “find a provider” websites will promote you for free.
- More referrals: Referral sources may be more likely to refer to you
- Accessibility: You’ll have the ability to serve clients of all socioeconomic backgrounds.
By accepting insurance as a private practice dietitian, you can expand your reach, reduce financial barriers for clients, and create more opportunities for your clients. However, there are some challenges you’ll have to overcome.
Disadvantages of Insurance for Private Practice Dietitians
If you’ve looked into the process of accepting insurance as a private practice dietitian, you know it can feel like a lot. It’s a lot more work to accept insurance, especially at the beginning when you’re setting up your systems and processes.
- Reimbursement rates can be low: It depends on your specific contract, but usually, insurance reimbursement isn’t very high.
- Additional time required: You’ll have to spend time verifying client’s benefits, billing insurance companies, and following up on claims.
- MNT hourly coverage: There are certain stipulations about how many hours can be covered for medical nutrition therapy.
- Only certain diagnoses: Insurance companies will only cover certain diagnoses.
- Time and risk: There’s always a risk that you may not get paid by an insurance company, and it takes time to get your money.
- Challenging situations: There are always more “what if?” scenarios when a 3rd party is involved in business.
- An in-person location: Some plans require the provider to have a physical office address, which cannot be your home address.
Now that you see some of the general pros and cons of insurance, make your own personalized pros and cons list, taking your strengths and personality into consideration.
Understanding the Process of Insurance in Private Practice
Now that you know some pros and cons of accepting insurance as a private practice dietitian, let’s talk about the basics of accepting insurance in private practice.
Becoming a provider can be a lengthy process. It can take up to 3-4 months to be approved with just one insurance panel.
The Application Process
- Apply: You’ll have to apply to each insurance panel directly through Provider Relations or through a network consultant.
- CAQH: The Council for Affordable Quality Healthcare is a national credentialing network of third-party plans. If you apply, you can then check off the individual insurance companies you want to apply for using their “enroll hub”.
- Credentialing: This is the process that providers will go through with the insurance company. The insurance company will ask for your credentials, license information, liability insurance, and all other documentation.
- Contracting: When you’re given a contract (including fee structure) for your insurance contract.
The Client Process
- Verify eligibility and benefits: Are there diagnosis restrictions? Is there a deductible? Is there an out-of-pocket max? What’s the maximum number of visits allowed? You will need to verify client benefits before seeing the client.
- Collect information: At the client visit, obtain a copy of their insurance card, and/or license/photo ID. Some insurance companies (and certain states) also require a physician referral.
Billing Insurance
To bill insurance, you’ll need the following items:
- Client information
- Practice information
- Date of service
- Time (units billed)
- Diagnostic codes (ICD 10)
- Physician referral (sometimes required)
You will need to bill within the required time (usually 6 months), and keep an organized system for payments and follow-up to keep the process flowing smoothly.
Mindset and Boundaries for Accepting Insurance
If you decide accepting insurance is the right fit for your life and business, you’ll greatly benefit from having some boundaries set with clients.
To do this, it’s important for you to have clear systems and policies in place to protect your time and set boundaries. Boundaries aren’t just for you, it’s for your clients too.
Here are a few areas you can have procedures to protect your boundaries:
- Implementing a thorough intake process
- Clearly communicating your billing and cancellation policies
- Establishing follow-up procedures
- Setting up office time to work on admin tasks related to insurance or hiring someone to assist in the process, like a biller.
By having these systems in place, you can maintain a positive work-life balance while reducing the stress that can be associated with managing and accepting insurance for your clients.
Advocating for Change
Dietitians and private practice professionals play an important role in advocating for change in patient care and insurance coverage. Insurance policies can be restrictive, with limited coverage for necessary treatments. This can lead to significant out-of-pocket expenses for clients, making it more difficult for them to get access to the care they need. Recognizing these challenges emphasizes the role that we play in advocating for better insurance coverage. Many professional organizations (like the Academy for Nutrition and Dietetics) are involved in this “fight” against insurance companies for better coverage, and hopefully, changes will happen soon.
However, professionals must make decisions that are best for them when deciding whether or not to take insurance. Think about your boundaries and what will work for YOU. It’s not an individual’s responsibility to fix a broken system.
The Pros and Cons of Insurance: The Takeaway
There are many pros and cons to consider when accepting insurance. It depends on how fast you want to grow your business, how much money you want to make, your ideal client’s diagnosis, access to care issues, location, and desire in this area.
Some of the pros include:
- An increased number of clients
- Less financial burden for your clients
- Increased accessibility for your services
Some of the cons include:
- Low reimbursement rates
- Additional admin time required
- Only certain diagnoses are covered
There is no one right answer to the question, “Should I accept insurance in private practice?”. It requires reflection, writing down your goals, and weighing the pros and cons to see what approach aligns with your life and business goals.
Want to work with me to build your private practice?
Business School is a comprehensive 6-month program designed to guide you through every stage of building a private practice: getting set up, seeing your first clients, growing until you’re fully booked, hiring a team, expanding your offers—and even learning how to coast when needed. Inside, you’ll follow a step-by-step curriculum with the flexibility to choose the path that fits your current stage of business and life. You’ll get access to advanced toolkits, templates, and systems for business topics like marketing and finances, but also for counseling skills and client support. Beyond the curriculum, you’re supported by personalized 1:1 coaching, weekly office hours, and monthly themes that address the real challenges of private practice. The program keeps you moving forward with built-in accountability that builds resilience and confidence so you feel like a legit business owner. Learn more and apply!
