Insurance Information Submission Lead

OnPoint is an in-network provider with Independence Blue Cross, Blue Cross Blue Shield, Cigna, Aetna, and United Healthcare.

Eligibility for coverage is dependent on the state in which you live (green, yellow or gray states below, plus New Jersey, Florida, Georgia, Ohio and North Carolina) and your plan specific benefits.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
What sex were you assigned at birth?*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
File Upload - Front of Card*

Cancelof
File Upload - Back of Card*

Cancelof
OnPoint Nutrition LLC is committed to and has implemented many safeguards to ensure its devices, services, websites and data systems are compliant with the regulations and conditions set forth in the Health Insurance Portability and Availability Act of 1996 (HIPAA).

We are committed to keeping all PHI (Protected Health Information) that is entrusted to us private and secure. We have instituted policies and procedures to ensure this data is kept confidential.
OnPoint Nutrition Payment Policy

We cannot guarantee payment or verify that definite eligibility of benefits conveyed to us or to you by your carrier will be accurate or complete. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at the time of service. Our office will make every effort to bill your insurance company in a timely manner. We strongly recommend, request, and encourage you to be familiar with, and verify your benefits with your insurance company prior to working with our team. Please be aware, that even then, it is still not a guarantee of benefits or payment. If your carrier determines that a particular service is not reasonable and necessary, or that a particular service is not covered under the plan, your insurer will deny payment for that service and the total cost of your program will become your responsibility. Clients are financially responsibility to pay the program balance in full if/when benefit limits have been reached.
Initials*
Missed Appointments

Clients are responsible for the cost of any missed/cancelled appointment. Insurance will not cover charges for cancelled or missed appointments. To ensure our team is appropriately compensated for their time, a $35.00 charge will be applied to the card we have on file for all cancelled or missed appointments not rescheduled within the same calendar week.
Initials*
Program Cancellations for Insurance Pay Clients

Program cancellations are based upon the date you specifically request such cancellation by email to billing@onpoint-nutrition.com. A minimum payment of $300.00 is required to cancel your program without financial obligation. If your insurance company has not reimbursed OnPoint Nutrition $300.00 for sessions as of the date of your cancellation, the client is responsible for payment of the difference.
Initials*
Should be Empty:

OnPoint Nutrition Payment Policy

Missed Appointments

Program Cancellations for Insurance Pay Clients