Nutritional Counseling Policies

Thank you for choosing ReConnections, LLC for your wellness goals. Your understanding of the following policies will help facilitate a positive working relationship.

Policies to Know:

  1. It is my responsibility to obtain a proper Nutritional Counseling referral prior to my visit and bring it with me. If my insurance company requires a referral, the dietitian will not see me without one unless I self-pay the fee for the entire visit ($125 for initial visit, $90 for follow-up appointment) upfront. The date of service will not be submitted to the insurance; therefore no refund will be given.
  2. My co-pay is due before my appointment. I may not ask ReConnections to bell me for my co-pay.
  3. If I fail to provide 24-hour notice to cancel and/or change my appointment, I will be billed a $25 fee, which must be paid before my next appointment.
  4. I will be billed a $25 fee for any returned check. All payments for a returned check and further payments will be due in cash or money order only.
  5. If my account is 90 days past due, it will be sent to a collection agency and I will be responsible for a $25 collections fee.

Insurance Policy to Know:

  1. I hereby authorize ReConnections to apply for benefits on my behalf for covered services rendered. Certify that all information given is correct, and authorize the release of information, including medical information, for this or related claims.
  2. I understand ReConnections will submit one appeal for a claim denied by my Insurance Company. When my insurance denies a claim twice, I will be responsible for paying ReConnections for the services rendered.
  3. I understand that my insurance company does not guarantee coverage of Medical Nutrition Therapy and that I will be responsible for all non-covered services rendered.
  4. I understand that all bills must be paid in a timely fashion. If I still have an outstanding balance when I arrive for my scheduled appointment, the dietitian will not see me.

Self-Pay Policies to Know:

  1. I understand that a Self-pay Package must be paid in full at my first appointment.
  2. I understand that a Self-pay Package offers visits at a discounted; therefore, these visits cannot be submitted to my insurance company by ReConnections.
  3. I understand that I can submit the visits to my insurance company for personal reimbursement, but that my insurance company may not reimburse me at all.
  4. I understand that reimbursement should be sent to me. If my insurance company reimburses ReConnections for the visits, the check will be voided and sent back with an explanatory letter.
  5. I understand that my insurance company may not reimburse me in full for the package; ReConnections will not reimburse the difference.