Payment and Office Policies
Clients are responsible for fees at the time of the appointment. Cindy does not accept insurance. Super bill provided, visits are eligible for work health savings account reimbursement. Depending on your goals, Cindy offers a combination of ways to purchase appointments.
Questions to ask your Insurance Company, when submitting your claims for reimbursement.
▪ Do I have out-of-network benefits to see aregistered dietitian? Let them know your dietitian will provide you with a superbill.
▪ 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?
My decision to stop processing claims now allows me to devote the time to each client that I believe is needed to delivery high quality care. Insurance companies only pay a limited amount for a limited amount of time for each appointment.
Accepted Payment Methods:
All payments are expected either before or at the time of service. You may choose from the following options.
Cash or check made payable to Cindy Carroll is preferred.
Pay pal or credit card.
Health Insurance/Payment of Fees Agreement
As a patient of Cindy Carroll, RD, LDN, RN, a nutrition consultant with Nutrition To Fit You, I hereby acknowledge and agree to the following conditions as it applies to nutrition and wellness counseling and payment of fees to Cindy Carroll, RD, LDN, RN.
1. I am responsible for understanding my own insurance coverage and agree to contact my insurance carrier to determine if treatment is covered.
2. I understand that I am responsible for obtaining a referral from my primary care physician and keeping it current, if my insurance requires it to be eligible for payment of nutrition services.
4. I agree to pay for all services at the time of visit or before via check, cash or credit card. I understand that Cindy will not process my insurance claim to my insurance appointment. It is my responsibility to process my claim if I want to receive reimbursement.
5. I understand I may be charged $50 for a no show or cancellation within 24 hours notice of my appointment.
6. A $25 fee will be charged for any checks returned for insufficient funds, plus any bank fees incurred.
I have read the above information and agree to all payment of fees as outlined above as they pertain to nutrition and wellness consulting with Cindy H. Carroll, RD, LDN, RN.
I also realize my work with Cindy H. Carroll RD, LDN, RN and the information and care she gives to me is not a substitute for examination, diagnosis or treatment by a physician, particularly in an emergency. If you believe you have a medical emergency, you should immediately call 911 or your physician. Never disregard medical or professional advice, or delay seeking it because of something you read on nutritiontofityou.com or care given by Cindy H. Carroll, RD, LDN, RN. Reliance on any information provided on nutritiontofityou.com or any linked websites is solely at your own risk.
Thank you for your cooperation!
Patient Signature Date