A Move Toward Expanded Private Coverage?
With Medicare now covering nutritional therapy for some senior citizens, an expansion of private benefits may not be far behind.
On Jan. 1, the federal program began carrying out a congressional mandate to provide nutritional benefits to seniors with diabetes or kidney disease. The change, which potentially could help 5 million senior citizens, 4.5 million of whom are diabetic, was driven by evidence compiled by the Institute of Medicine.
The institute, which advises the federal government on medical issues, found that medical nutrition therapy can help manage and improve the health of people with diabetes, kidney disease and cardiovascular conditions such as high blood pressure, high cholesterol, high triglycerides and heart failure.
Federal health officials, who are supposed to make recommendations about expanding the program by July 2003, are likely to propose coverage for nutrition therapy for cardiovascular illnesses as well.
Because private insurers and managed care plans typically take their cues from Medicare, nutritionists expect that more of their services will be covered. At this point, nutritional counseling benefits vary widely among private insurance plans.
Aetna, for example, covers doctor-prescribed nutritional counseling for its members with diabetes, obesity-related medical conditions or other chronic diseases that can be improved through diet.
HealthNet pays for a consultation with a registered dietitian or certified nutrition specialist when it is deemed “medically necessary” by the physician and the physician’s medical group, said spokesman Brad Kieffer. Typically, the physician manages the patient’s condition afterward.
Nutritionists in private practice say that most of their clients must pay for the counseling themselves but that health plans increasingly recognize the benefits of what they do.
“In an ideal and enlightened world, they would realize it’s in their interest to keep their insured people healthy,” said Carolyn Katzin, a certified nutrition specialist with a private practice on Los Angeles’ Westside.
Although access to nutritional counseling generally is limited to the insured or those who can afford to pay out of pocket, there are a few cases in which those without insurance may be able to get services. For example, around the country there are some programs being offered in which Medicaid will pay for nutrition care for children with special needs.
When St. Vincent’s Hospital in downtown L.A. opened its Center for Health and Healing this past week, it began offering nutritional counseling not just to its paying patients but also to those without insurance. The center hopes to attract enough paying clients to underwrite ongoing services for the uninsured once a two-year grant from the Sisters of Charity expires, said Carolyn Edwards, a certified nutrition specialist who serves as a consultant to the center.
