Why I Accept Blue Cross Blue Shield as a Dietitian


As of October 2, 2022, Christine Byrne Nutrition is officially an in-network dietitian with Blue Cross and Blue Shield (BCBS) of North Carolina

Whether or not to accept health insurance was a big internal debate for me, so I figured, why not be transparent about that decision-making process? Hopefully, it’s helpful to any providers reading who are in a similar situation, and to everyone else reading who doesn’t understand why certain providers accept insurance while others don’t. 

Image of a white planner on a table, with scrabble tiles that spell out "health insurance" — blue cross blue shield dietitian

First, North Carolina is a good state to be a Blue Cross Blue Shield dietitian. 

In many states across the country, it’s tough for small private practices to be in-network — particularly if the owner is the sole or primary income for a family — because reimbursement rates (the set rate that insurance companies agree pay providers per appointment/service) are just too low. That’s a big reason why many providers choose not to be in-network, particularly in big cities with high costs of living.

Another issue is that some plans in some states don’t provide very good coverage for nutrition counseling. For example, a plan might cover just 6 visits per year. Or, it might only cover nutrition counseling for people with certain diagnoses, like diabetes or renal disease. The type of nutrition counseling I (and many others) offer works best as a long-term thing. I see clients weekly for many months at a time. (Some people have been with me since I started a year ago!). Having just 6 visits covered wouldn’t work well. And, since I work with primarily eating disorders and disordered eating, it wouldn’t make sense to be in-network with a plan that only covers nutrition counseling for diabetes.

Here in North Carolina, the reimbursement rates with BCBS NC are fair. Many BCBS NC plans cover nutrition counseling as preventative care (which means you don’t need a relevant diagnosis). And, most of these plans cover nutrition counseling in full. That means clients don’t have to pay anything out of pocket. That’s a massive benefit to the client. 

Using health insurance benefits for nutrition counseling takes some pressure off of our counseling relationship. 

It’s an indisputable fact that change takes time. Clients who come in for just a few sessions after struggling with food for years aren’t going to get much benefit. Knowing that insurance benefits are covering the cost of sessions means that we can take our time with nutrition counseling. We can spend time really getting into the nuances of each person’s relationship with food, instead of feeling rushed to make quick “progress” that won’t last.

(Note: I know many out-of-network providers who do a great job of setting this slow-progress expectation with clients!)

Being an in-network provider makes nutrition counseling accessible to more people at little or no out-of-pocket cost.

Like I mentioned, many Blue Cross Blue Shield plans in North Carolina consider nutrition counseling to be preventative. That means they cover it in full (or close to it). Much of the time, they’ll pay for ongoing weekly visits. That means clients are able to get the long-term support that’s needed for eating disorder recovery and healing one’s relationship with food.

Network participation crosses state lines.

Although I only see clients in-person in Raleigh, North Carolina, I offer virtual appointments for folks in several other states. If you have a BCBS plan in a state I’m allowed to practice in, I’m probably an in-network provider! Go here to see the states I’m allowed to practice in.

The downsides? More admin work for both me and my clients, and the possibility for confusion.

Of course, for all the pros of taking insurance, there are some cons. The biggest one is that it’s a bit more work for everyone involved. Before clients book a session, they must call their insurance company and verify whether their benefits include nutrition counseling. (I have a script for that call here.)

On my end, it takes a little extra time to submit claims to insurance exactly the way they want them. And, I need to make sure my notes are formatted the right way and contain the right info. The insurance company has the right to ask me to send those notes over at any time). 

There’s also the possibility for confusion. Insurance companies change their policies sometimes. A client might be told by one representative that a service is covered, when actually it’s not. This means that the client must may for the service out of pocked.

Or, a client with an out-of-state BCBS plan might have very different benefits and coverage than those with in-state plans.

This is rare, but unfortunately it happens. It’s also why it’s so important to get a reference number every time you call your insurance company! If you have one written down, they’re more likely to honor whatever the representative told you on that call.

Overall, I think it’s a win.

Despite some extra admin work and the possibility for some confusion, I’m so excited to offer in-network nutrition counseling. The pros outweigh the cons, I think. 

The world needs more anti-diet dietitians, and offering in-network services makes us that much more accessible to more people. 

Plus, I’ve already seen a massive increase in new client inquiries since I announced that I was in network as a Blue Cross Blue Shield dietitian (about 20 in the first week!). So, clearly there’s a demand.

If you’d like to learn more about nutrition counseling and request an appointment, you can do that here.

If you’re struggling with an eating disorder or disordered eating, I can help! I’m a dietitian who takes an anti-diet, body-positive, identity-affirming approach to recovery and healing your relationship with food. . Learn more about nutrition counseling, offered in Raleigh, NC, and virtually to clients in several states. Not ready to commit to counseling but want more information about the anti-diet approach? Subscribe to my weekly newsletter.

You might also like:

What Is Orthorexia — And Do I Have It?

18 Dietitian-Recommended Snacks for Eating Disorder Recovery

What Is Disordered Eating, Exactly?

Body Acceptance Is Key to Intuitive Eating. Here’s How to Practice It.

Free Intuitive Eating Course

Looking for a free intuitive eating course? Whether you’re new to the anti-diet approach or you’ve been trying to work towards intuitive eating for a while, our 5-Day Intuitive Eating Starter Course is a great start for anyone who’s tired of obsessing over “wellness” and constantly struggling with food and body acceptance.


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