Did you know that Medical Nutrition Therapies includes:

• Cardiac Disease

• Pre-Diabetes/ Diabetes

• Bariatric Surgery (PRE/POST)

• Weight Management

• Hair & Skin Nutrition with Healthy Eating

• Eating Disorders

• Cancer

• Kidney Disease

• Autoimmune Disorders

• Celiac Disease

• Sjogren’s syndrome

• Multiple Sclerosis

• Polycystic ovary syndrome (PCOS)

• SIBO

• Gastrointestinal Disorders

• Pediatric Nutrition

  
  

I AM AN IN-NETWORK PROVIDER AND HEALTH INSURANCE COVERS MEDICAL NUTRITION THERAPY FOR THE FOLLOWING PLANS:

• HORIZON BLUE CROSS BLUE SHIELD OF NJ

• BLUE CROSS BLUE SHEILD

• HORIZON NJ HEALTH (MEDICAID)

• HORIZON NJ FAMILY CARE (MEDICAID)

• AETNA (NJ & NY)

• CIGNA

• EMBLEM HEALTH (GHI) - (NJ AND NY)

• MEDICARE/ HUMANA

• AMERIHEALTH NJ

• UNITED HEALTH CARE/OXFORD)

We verify your insurance as a courtesy, but it is the responsibility of the client.

We encourage you to call your health insurance company before an appointment and say that you would like to verify your benefits. Here is a guide for you when you call:

1. Do they cover nutrition counseling, for CPT Codes 97802, 97803 and 97804?

2. If they ask for a diagnosis code, use code Z71.3 - which is for preventative nutrition.

3. Ask how many visits are covered per calendar year, and whether or not you have a copay.

If I am out of network with your insurance, you may still be able to use your health insurance for the visit! Just ask your health insurance company if you have “out of network” benefits for the above CPT codes (97802 & 97803) and diagnosis code Z71.3 (for plans other than Aetna and UHC). For Aetna and UHC, just ask for medical nutrition therapy coverage for the CPT codes above - including many visits.

TIPS IF YOU HAVE A HSA ACCOUNT

If your health insurance plan is not listed above, or you have a high deductible that must be met before the insurance covers any services, or you do not wish to use your health insurance, you can use your HSA account to pay for nutrition visits!

That means using pre-tax dollars for an investment in your health…what could be worth more?!

VIBRANT NUTRITION & WELLNESS, LLC

Waiver of Liability

Disclaimer

1. The Scope of Practice of Vibrant Nutrition & Wellness, LLC: Annette O’Neill, RDN is not a physician or psychologist, and the scope of nutrition counseling does not include treatment or diagnosis of specific illnesses or disorders. If you, the client, suspect you may have an ailment or illness that may require medical attention, then you must consult with a licensed medical professional.

 1.1: I, the client, understand that Annette O’Neill, RDN is a Registered Dietitian/Nutritionist and does not dispense medical advice nor prescribe treatment. Rather, she provides nutrition counseling and coaching to support my health and wellness goals. While nutritional and botanical support can be an important complement to my medical care, I understand nutrition counseling is not a substitute for the diagnosis, treatment, or care of disease by a medical provider.

 1.2   Waiver and Consent - I, the client, volunteer to participate in the nutrition counseling, retreat, group class program provided by Vibrant Nutrition & Wellness, LLC and I understand that this is separate from the care that I receive from any medical facility.

2.  Personal Responsibility and Release of Health Care Related Claims:

2.1. I, the client, acknowledge take full responsibility for my participation in the counseling and coaching program with Vibrant Nutrition & Wellness, LLC, and release and discharge and hereby hold harmless, now and in future, Vibrant Nutrition & Wellness, LLC and the respective agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, in law or equity present or future, arising out of or connected with my participation in any nutrition program including any injuries resulting therefrom.

2.2. I, the client, expressly assume the risks of nutrition coaching, classes, or retreat sessions, including the risks of trying new foods, and the risks inherent in making lifestyle changes. I recognize that specific foods may create allergic and possible fatal reactions, most specifically, products containing nuts. I have therefore specified any food allergies/ sensitivities I am aware of on the Intake Form. I am aware that specific foods may interact with certain medications. I have discussed the side effects of all of my medications with my doctor or pharmacist

3.   Confidentiality

3.1 I understand that Vibrant Nutrition & Wellness, LLC will keep my (the client’s) information private, and will not share my information to any third party unless compelled to by law or with my explicit, written consent - See HIPPA form on “Healthie Portal”

4. Payments and Refunds

4.1 I the client, understand that payments are due at the time of service and there are no refunds for payments made to Vibrant Nutrition & Wellness, LLC and Annette O’Neill, RDN

4.2 In the event that my (the client’s) health insurance does not cover any part of my nutrition consult(s), I understand that I am responsible for payment for services provided by Vibrant Nutrition & Wellness, LLC.

5. No-Show/Cancelation Policy

5.1 I, the client, understand that cancellations must be provided at least 24 hours in advance. In the event that a cancellation is made in less than 24 hours of a scheduled appointment, I understand that I may be charged a percentage of the session payment. This does not apply in the event of a medical emergency and medical proof must be provided.