Good Faith Estimate Notice
PAYMENT & INSURANCE:
Please contact for current fee schedule.
All sessions are considered “fee for service” and “out of network” and due at the time of service. Although we do not file insurance claims, we can provide you with the documentation necessary for you to file a claim with your insurance company to request reimbursement. We do not participate in medicare, nor do we provide medicare “opt out” letters. We cannot guarantee that reimbursement requests will be approved.
Many Health Care Spending Accounts (HSAs) and Flexible Spending Accounts (FSAs) can be used to pay for visits with a registered dietitian. We accept HSA/FSA cards with a major credit card logo. Please bring an alternate form of payment the first time you are using HSA/FSA cards in case there is an issue. A receipt can be provided upon your request for all services.
Cash, check, FSA and credit cards accepted.
Session fees are due at the time of service.
Submitting Claims to Insurance for Out-of-Network Reimbursement
If you have health insurance, you might have “out of network” benefits that could cover a part of your in-office appointment fees. Some plans cover nutrition therapy and others do not. Some plans will also cover telemedicine sessions, whereas others will not. Contact your insurance company directly to determine if your insurance company will reimburse you for all or part of the cost of appointments. We will provide you with the medical superbill when a nutrition-related diagnosis code is provided. You can then submit this form to your insurance company for reimbursement.
Questions to Ask Your Insurance Company:
– Do I have out-of-network benefits to see a registered dietitian? Provide the following CPT codes to your insurance company representative: Dietitian: initial session 97802 and follow-up sessions 97803
– What percentage do you cover?
– Is preauthorization required in order to submit an out-of-network claim?
– What is the deductible, and how much of the deductible have I met?
– How many sessions are covered and within what time period?
– What forms do I need to submit to qualify for reimbursement?
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.
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, visit www.cms.gov/nosurprises.
Session space is limited, and we want to ensure that session times are used wisely and made available to clients in need of our services. Therefore, 24 hour notice of cancellation is required. Last minute session cancellations and no shows are billed at 100% of the session fee. Also note that if requesting reimbursement, cancellation and no-show fees cannot be submitted to insurance. So please come to your appointment!