Patient Financial Responsibility Policy
This is a statement of the financial responsibility policy for Healthy Nutrition Solutions.
If you would like to use any available nutrition counseling benefits of your commercial health insurance or Medicare policy, I will call to verify your nutrition counseling benefits to the best of my ability by the Monday prior to our first scheduled appointment.    If you also would like to verify your nutrition counseling benefits up to 48 hours before our first scheduled appointment, please text me or email me of this intention and I will provide you with the procedure and diagnosis codes I will be billing so you can verify specific benefits and not general benefits.  
I have been verifying nutrition counseling benefits for over 8 years and I am rarely misquoted.  However, there are sometimes exceptions that I cannot control. I always obtain a reference number to my call when I verify your nutrition counseling benefits. If I am misquoted there is a possibility that the claim will ultimately be paid as a misquote if the initial claim is denied and cannot be corrected by using a different diagnosis code. However, there is also the possibility that the claim will never be paid by the insurance company if it is denied.  I cannot make the insurance pay any claim and there is only so much administrative time I can put toward trying to get a claim paid on your behalf.
I will call the insurance company to inquire as to any denied claims.  If it is a billing error on my part I will resubmit with the correct information.  If the claim is denied because I was misquoted that you have nutrition counseling benefits on your insurance policy then I will attempt to appeal the denied claim as a misquote.  Not all insurance companies handle misquotes the same way as they all have “disclaimers” of quoted benefits.
If you choose to appeal the decision of the insurance company (which I would encourage) I agree to delay collecting any funds that you owe me for up to 45 calendar days after notifying you of the non-payment while the insurance company is reviewing your appeal.  After 45 calendar days you agree that I may charge your credit card on file the rate of $80.00 per hour for each hour we have spent together as you understand you, not your insurance company, are ultimately responsible for the time we have spent together. (Initial Below) *
Acknowledgement: I have read and understand the financial policy of Healthy Nutrition Solutions as described above.  I agree to pay, after adequate time for an appeal, any amounts due to the provider, Lesley Lovely, MS, RD, CDE when, for any reason, my insurance company refuses to pay the claim for services rendered. My Name and Initials throughout this form indicate that I understand my financial responsibilities. *
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