Here are some general questions you may want to ask your insurance carrier in order to determine your coverage:

• Do I have insurance coverage for dietary surveillance under preventative services, nutrition, nutritional counseling, or medical nutrition therapy?
• What is my Out-of-Network and In-Network coverage? Is the clinic, Starkel Nutrition, In-Network?
• Do I need a PCP (Primary Care Physician) referral or pre-authorization to schedule appointments?
• Do only certain diagnoses qualify for nutrition counseling coverage? If so, which diagnoses qualify?
• Do I have a deductible to cover?  If so, how much? Do I need to fulfill the deductible before my insurance will begin covering sessions?
• How many nutrition sessions do I get per year or per lifetime?
• Do I have a co-pay/coinsurance?  If so, how much per visit?

Metabolic Reset Program is part of Starkel Nutrition, a nutrition clinic that is credentialed with the following insurance companies. Each plan under these carriers may have different coverage for nutrition, always check with your insurance provider for specific benefits and coverage.

• Blue Cross Blue Shield
• Regence Blue Shield, Uniform, Bridgespan
• Aetna
• Kaiser Permanente: Access PPO, Options PPO, or Omni PPO
• First Choice (some plans)
• Cigna (some plans)
• Premera Blue Cross/LifeWise

Initial appointments are 50-60 minutes in length. During the first appointment, we will review your intake forms. We may also conduct some clinical tests and/or a physical examination. These may include observation of your mouth, nails, hair, weight, blood pressure, oral mineral tests, etc. Some of these tests may be conducted in subsequent appointments and have additional fees, which will be discussed.

Once all the information on the forms has been discussed and your goals are clear, we will discuss a plan forward for you regarding the health conditions you are interested in treating. There is occasionally time to start nutrition education in the first appointment, but usually it is devoted to a complete intake and creating a plan. Over time, we will work on nutrition education and work the plan which will include all or some of the following:

• Recommended lifestyle and eating changes
• Recommended additional blood tests
• Referrals to other practitioners
• A nutritional supplement regimen to help you address any nutrient deficiencies and reach your goals efficiently and with optimal health

We offer both in-person and Telehealth appointments for our clients.

• Complete online questionnaires (electronic)
• Labs from last 24 months
• Your insurance card and a photo ID

Once you have an appointment scheduled, we will send a number of online questionnaires to you through the Patient Portal. It normally takes about an hour to complete the questionnaires. If you cannot fill out the questionnaires ahead of time, please arrive 30-45 minutes prior to your appointment to complete the paper versions of the questionnaires (failure to do so will result in a shortened appointment time). Details on the questionnaires follow.

• Health History Intake Form – This is the your health history where you communicate your goals, history and any other relevant information.
• The Medical Release Form, and Instructions for completing it, is sent to your health care provider, usually your doctor. We use this form to request your labs, if you have them, from your doctor/health care provider. Although chart notes are not necessary, if you have an existing health condition, we will be able to more quickly address it if we have your medical history. These are most useful at the 2^nd appointment. For those billing insurance, we also need you to fill-out the top portion of the Diagnosis Code Form. We will send this to your doctor along with the signed Medical Release form to obtain diagnosis codes, which we need to bill your insurance.
• Patient Registration Form – This is for insurance carriers. If you are coming to see us for an appointment that is covered by insurance, please be sure to fill this out. Bring your insurance card and driver’s license, as HIPAA (the privacy act) requires us to have these on file.
• Privacy (HIPAA) Statement and Agreement – this pertains to patient confidentiality.
• Cancellation/No Show Policy and Credit Card Authorization – We require that a credit card be saved on file to reserve your first appointment. It is only charged with your permission if you make purchases during your appointment or for late cancellation/no-show fees (see Cancellation policy below).

This is a list of blood chemistry labs that give a basic overview of nutritional health. If you have had these labs done within the last six months, please bring them in. If you have not, you will discuss these and other possible labs during your appointments.

If you and your nutritionist decide to get the following tests, you can ask your doctor if he/she will order them. If yes, they may be covered by insurance. Your nutritionist can also order labs at discounted rates. The cost for the following tests is $150 plus extra for the expanded thyroid panel, which is passed directly on to you. However, if you order through your nutritionist, they are not covered by insurance.

Please make sure you have your blood drawn after a 12-14 hour fast (no food, but water is okay), so it is recommended that you have blood drawn early in the morning and bring breakfast with you.

Do not take Vitamin D supplements 4 days prior to your blood draw.

• CBC with differentials including platelets (complete blood count)
• Lipid profile (total cholesterol, HDL, LDL, triglycerides)
• Liver profile (ALT/SGPT, albumin, alk phos, AST/SGOT, bilirubin, globulin, LDH, total protein, GGT)
• Kidney panel (BUN, serum creatinine, uric acid)
• Minerals and bone (iron, calcium, phosphorus)
• Fluids and electrolytes (serum chloride, potassium, serum sodium, CO2)
• Fasting BG
• Vitamin D 25 hydroxy
• Blood type
• Ferritin

For those with thyroid issues:

• Complete Thyroid panel w/TSH (total T-4/thyroxine, T-3 uptake, free thyroxine index/FTI – T-7, TSH)
• Anti-TPO, anti-TGB antibodies

The short answer is no, we do not prescribe medications and can not authorize a refill of your current medication. That being said, we work to provide effective treatment via individualized lifestyle and diet modifications that we “prescribe.” While we recognize that not all conditions can be treated without medication, we are extensively trained in medical nutrition therapy and can be a valuable resource for managing many medical conditions such as diabetes, cancer, and heart disease. For complex medical conditions we can serve as a valuable member of your health care team, working collaboratively with your primary care providers to individualize your treatment plan to meet your unique needs and optimize your overall care.

Our professional opinion is that most of us do not get our optimal amount of nutrients on a daily basis from our foods. Our food supply has dramatically changed over the years, and we do not need to ingest as much food (and accompanying nutrients) as we used to, because we all have relatively sedentary lives. As we are working with you to achieve optimal health, we will recommend some base-line supplements to you for good general health. In addition, if you are working on a specific health condition, we may recommend other supplements to bring your body back into balance more quickly. For most conditions, these additional supplements may be discontinued later, once the imbalance is addressed.

Payment is due at time of service. At this time, we are credentialed with Regence Blue Shield, Aetna, First Choice, select Kaiser Permanente PPO plans, Uniform, Cigna, Premera (including LifeWise), and Blue Cross Blue Shield. Your PLAN, even if it is with one of the above insurance companies, may or may not cover nutrition. If your insurance does not cover any or all of your appointment (such as in the case of unmet deductibles, uncovered services, etc.), A&R Billing Services will send you an invoice for the balance. It is your responsibility to pay this upon receipt.

For cash pay patients, we offer an out-of-pocket discount. We accept cash, checks, credit, and debit cards.

We request that all appointments you cannot make are cancelled at least two (2) business days (Mon-Fri), i.e. 48 hours, during business days, in advance of your appointment to avoid a $175 cancellation fee, and more importantly to allow someone else to fill this time slot. This fee cannot be billed to insurance.

This means that if your appointment is on a Saturday at 3 PM, you would need to contact our office by Wednesday at 3 PM to avoid the late cancellation charge.

If you have any last-minute scheduling questions or you need to cancel your appointment, please call or text us at (206) 853-0534 (your direct reply to an appointment confirmation or reminder email or text will not get delivered to us), send an email to our Admin Staff or contact Administrative Assistant on ChARM.

We are physically located at 4500 9th Ave NE, Suite 300, Office #42, Seattle, WA 98105. However, we see clients both in-person and via Telehealth.

Our door is to the left of the AMC theater entrance, where you will take the elevator up to the 3rd floor. Once there, go straight, take a left at the end of the corridor and make a right at the second hallway across from the small waiting area. Don’t hesitate to call us at (206)853-0534 if you are having trouble finding us.