Self-pay rates (not billed to insurance):
- $150 per initial intake (53-60 minutes)
- $130 per 53 minute follow-up session
- $65 per 25 minute follow-up session (by request)
Under the law, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including nutrition services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including nutrition services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, how to dispute a bill, or see your Estimate, visit www.cms.gov/nosurprises or call (800) 368-1019
I accept the following insurances:
- Blue Cross Blue Shield plans (excluding Legacy LHP and Blue High Performance Networks)
- Oregon Health Plan (ONLY if the medical/physical health portion of your plan is through CareOregon, OHSU Health, PacificSource Community Solutions or Open Card)
- Moda (Connexus, Synergy, and HMC & OHSU Health networks ONLY)
- PacificSource commercial plans
- Cigna
- First Choice Health
I am not in-network with any insurance plan not listed above. I can, however, bill as an out-of-network provider if you have out-of-network nutrition benefits or provide you a superbill that you may submit to your insurance company for potential reimbursement. I am able to accept FSA and HSA cards as a form of payment. Unfortunately I am not billing services for new clients with Medicare; I greatly apologize for the inconvenience.
Please be aware that even if I am in-network with your insurance, each plan is different and therefore coverage for nutrition sessions is not guaranteed.
To verify your insurance benefits for nutrition counseling, please call the number on the back of your insurance card and ask them the following questions:
1. Is Tessa Komine and/or Fearless with Food, LLC considered an in-network provider under my plan? If not, what are my out-of-network nutrition benefits?
2. Do I have benefits for nutritional counseling, using CPT codes 97802 & 97803 and diagnosis code Z71.3?
3. If applicable: Do I have different coverage with an eating disorder diagnosis (same CPT codes)? If so, which diagnoses?
4. Do I have a deductible to meet before insurance covers? If so, how much have I met so far?
5. Do I have a copay or coinsurance for visits?
6. Is a doctor’s referral required?
7. Is there a limit on the number of visits allowed?
8. Are telehealth visits covered?
9. Can I get a reference # for the call?
Please be aware that information given by your insurance company is not a guarantee of coverage.
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No-show/late cancellation policy:
For missed appointments or cancellations within 24 hours of the scheduled appointment, there is a $65 fee which can be waived at my discretion (e.g.in the event of a medical/family emergency). For OHP/Medicaid clients this fee does not apply but the policies described in the Practice Policies & Consent to Treatment form will take effect instead. Please note that I am not able to bill insurance for missed appointments.