What should I expect from health insurance and a registered dietician ?

May 31, 2018 6:42 AM

I went to see an registered dietician today because I need to lose some weight, my health insurance covers it and I’ll be leaving my job in two months so I’d like to get out of it what I can. I left feeling confused about if my expectations were in line or not and a bit let down that it might not be as helpful as I thought. What do you expect from your RD and what does insurance cover?

- I thought insurance (BCBS NC) would cover everything which is why I made the appointment in the first place
- turns out that it only covers RD counseling (and I’m still not really sure what that means)
- it would cost $25 for a metabolic test
- they charge $250 to make a meal plan for you
- I found the RD through the BCBS providers page and his card includes NAME, MS, RD, LDN
- He works through/for the company Total Nutrition Technology
- I liked working with him and would be happy to continue but I’m starting grad school in August so I really don’t want to throw money at this problem if I don’t need to
- I’ve contacted a coworker who has been to an RD to see what they covered for her but haven’t heard back yet. She works in another town so I can’t see who she sees.

We’re my expectations out of line or should I be looking for something else from an RD (and how do I find it?)

posted by raccoon409 to Health & Fitness (10 answers total)

have you looked at your summary of benefits? you should be able to get exactly what is covered from that and see if your plan is paying what you can expect it to.

i would say most plans do not cover things like this the same as they would cover you going to the doctor for a standard medical reason like the flu. in fact many plans wouldn't cover it at all.
posted by domino at 7:19 AM on May 31, 2018 [1 favorite]

Best answer: I'm in a RD program right now. One of my classmates worked for Total Nutrition Technology before starting this program and she's mentioned a few times how people for Total Nutrition tend to push meal plans and the other extras because their dietitians work by commission only. They don't receive a salary by Total Nutrition and only receive a cut of the insurance billing for each client they see (on top of the extras they sell).

Insurance billing can only cover "counseling" but that includes everything a dietitian can do (everything from diabetes management to weight loss to diets for kidney failure). It's just insurance and billing for this field is relatively new and undeveloped.

I honestly think that you should find someone else since you're feeling let down by this guy.
posted by astapasta24 at 7:27 AM on May 31, 2018 [4 favorites]

I have BCBS in another state. Mine covers three visits with a registered dietician a year at my normal copay. Usually they have you make a log of what you're eating and how much for a week or two, then they suggest tweaks to lower your calories/carbs/fat/whatever. I have been offered recipes, but I've never been charged for a meal plan. That sounds weird to me. Don't pay that.
posted by Bistyfrass at 7:28 AM on May 31, 2018

I've been referred to what I would consider legitimate RD's, and I've been referred to what I would consider sketchy ones. Education and credential-wise, they're usually the same. But the sketchy ones push shakes and bars and expensive meal plans instead of real food. I encountered one of these through my (legit-seeming board-certified) endocrinologist. It was a hard sell like a time share, with an extra dose of "All of your health problems are because you're fat, and you'll always be fat and die from being fat if you don't buy what I'm selling RIGHT NOW." It was awful, and I reported the whole mess to the state board. Though I have no idea whether anything came of it.

There are RD's around that will provide some guidance, including some meal planning advice withou the hard sell BS, but the other type is just as common if not more common. I have personally never received advice from an RD that was better than the common knowlege on Google (or AskMefi!). I expect more individual care if I'm going to the trouble of meeting with someone, but it tends to be more one-size-fits-all advice.
posted by terilou at 7:33 AM on May 31, 2018

I saw 2 RD's years and years ago. I hated both. One pitched shakes heavily and the other kept pushing "diet" foods. In the last two years I have used my insurance to talk via phone to a RD several times, much better experience. No cost (but I do have HBP) and they were much more helpful in helping me refining my diet and giving me pointers on a few other related issues. Look at your policy, you may have some "wellness" benefits that are low cost or free.
posted by ReiFlinx at 7:58 AM on May 31, 2018

Best answer: I have never had a productive encounter with a registered dietician, and I have never gotten anything from an RD that I couldn’t have gotten from a book or already knew as a self-educated consumer.
posted by bq at 8:45 AM on May 31, 2018

Response by poster: To clarify- he isn’t pushing any shakes or food you have to buy from them. He actually seemed pretty reasonable in his meal plan approach (and one that likely fits with mine) i just thought that “counseling” would cover making a meal plan too and wasn’t sure if that was within the bounds of expectations. It’s seeming like offerings can be all over the place from RD’s as well as their helpfulness.
posted by raccoon409 at 9:01 AM on May 31, 2018

Best answer: I have BCBS-NC insurance and am currently also seeing an RD weekly, beginning about a month ago. My insurance has unlimited visits, no copay. She has been working with me and seriously tailoring her counseling to my body, my health issues, my habits, and my constraints. We have spent a good deal of time learning about me, and that has been through me paying attention to feeling hungry/full, journaling what I eat, my hunger levels, any other observations about how I feel emotionally or physically, etc. We have tried meal plan versions and we have tried looser versions to see which I am more compatible with. The overarching guidance is looking at motivation. I definitely have health as a motivator (weight, numbers, energy level), but I also have some behavioral changes I want to make as well. I hadn't realized that latter part until I had been tracking my consumption for a few weeks. So far I am very pleased.

Ultimately, just talk to him about expectations and such. Ask him what his game plan is.
posted by Stewriffic at 9:56 AM on May 31, 2018

Best answer: So I didn't see he was charging extra for a meal plan. To be clear, when I said "meal plan" it was very loose. Like 8 a.m. coffee with half and half, vegetable or fruit, meat, fat. 10 a.m. snack 2T nuts/1 T pb/1 oz cheese/1/4 cup sour cream dip and a vegetable/fruit. 12 p.m. etc. It wasn't fleshed out at all.
posted by Stewriffic at 11:13 AM on May 31, 2018 [1 favorite]

Response by poster: Hey all, I had my second appointment yesterday and I have to say that it was underwhelming. It’s basically motivational counseling and making small achievable goals. All good in theory but nothing new for me. I think the greatest asset would be the feeling of accountability toward someone but I don’t think there’s anything there that’s particularly helpful.

Thank you for your help and managing my expectations.
posted by raccoon409 at 8:41 AM on June 8, 2018