• Acknowledgement of Financial Responsibility

    Anne Till Nutrition Group
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    Please read each of the following sections carefully. You will be asked to initial each individual section to ensure that you understand our policies.
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    Insurance Reimbursement

    Anne Till Nutrition Group dietitians/nutritionists are currently contracted with BCBS, BCBSNC, BCBSNC-State Plan, United Health Care, Aetna, Cigna, and Medcost. We will file claims on your behalf only for these health insurance companies. You will remain responsible for all co-pays, coinsurances, and deductibles as applicable and as prescribed by your specific plan. We will verify your benefits with your health insurance (if you are a member of the companies that we are in-network with). Verification of benefits is never a guarantee of payment by your insurance company. You will remain responsible for all fees associated with services rendered by the office if your insurance company fails to cover these services - even after we have done our best to obtain the most accurate and up-to-date information.

    If you are with other insurance plans it is necessary for you to verify what benefits are available to you before receiving services from Anne Till Nutrition Group. For all health insurance companies that we are not in-network with, we are a fee-for-service practice, where payment is due in full at the time of your session. You may however still receive reimbursement from your insurance company for services rendered by us as an out-of-network provider, so as a courtesy, we will gladly provide you with a detailed statement at your request.

     

    Out of Pocket Fees

    Anne Till Nutrition Group's out-of-pocket fees are as follows:

    Initial Consultation Adults and Children (90 -120 minutes)                  $275.00

    Second Consultation Adults and Children (60-90 minutes)                   $165.00

    Follow up Sessions Adults and Children (60 minutes)                          $110.00

    Follow up Sessions Adults and Children (90 minutes)                          $160.00

    Each additional 15 minutes                                                               $25.00

     

    Other Fees

    Nutrition Care Plan Formulation Fee

    There is a one-time fee of $65 for the formulation and creation of your nutrition care plan that is not covered by your insurance. This fee covers the time outside of the face-to-face time your dietitian spends creating your nutrition care plan. This plan is required by Anne Till Nutrition Group as we have found this to be highly effective in helping patients. Payment for your nutrition care plan is due at the time of your initial consultation unless you are paying out of pocket. The fee for the nutrition care plan for patients paying out of pocket has been distributed amongst the initial and the second consultation fees.

    Aetna additional fees apply. Aetna only pays up to 1 hour of services. If you have Aetna then you will be responsible for an additional fee of $75 for your initial visit to cover the hour that is not covered by Aetna. You will also be responsible for the additional fee of $35 for your second visit to cover the half hour that is not covered by Aetna. These fees would be waived if you were to split up your visits. This will be discussed at the time of scheduling with the administrative staff.

    Payment is due at the time of your session. We accept checks, payable to Anne Till Consulting LLC and major credit cards including MasterCard, Visa, and Discover. Receipts for our services are made upon request. Please note that fees are usually increased annually to compensate for our overhead expenses.

    Notice of Collections and Legal Fees

    If you have an outstanding balance with Anne Till Nutrition Group, we will provide you with a statement through the mail. If we do not receive a payment within 120 days of the date of service then we will hand your balance over to collections. Additional fees may be incurred as a result of this process which you will be responsible for over and above your outstanding balance. These fees will relate to the cost incurred for appointing a collection agency and the legal fees associated with collections.

    Questions about fees and payments should be discussed prior to or at the beginning of your appointment. Fees for phone sessions and missed appointments should be mailed to the address above, or you may bring it to your next session if one is scheduled within the next 7 days. A 10% late fee will be assessed monthly on any unpaid balance of 30 days or more.

    Fees are subject to change with a 30-day in-office and website notice.

    By initialling below you are indicating that you understand that Anne Till Nutrition Group will only file health insurance claims with the following health insurance companies: BCBS, BCBSNC, BCBSNC-State Plan, United Health Care, Aetna, Cigna, and Medcost. If you have health insurance benefits with another health insurance company and you wish to receive reimbursement for services, you must file claims directly to your insurance company.

    By initialling below you are indicating that you understand that verification of benefits is not a guarantee of payment by your insurance company. Payment of benefits is subject to all terms, conditions, limitations, and exclusions of the member's contract at the time of service. You understand that if your insurance does not pay as per stated in your benefits that you will be financially responsible for your visit(s).

    By initialling below you are indicating that you understand that payment for the nutrition care plan is due in full at the time of your initial session and is not optional.

    By initialling below you are indicating that you understand the out-of-pocket fees listed above. You understand that you will be responsible for payment at the time of your appointment if you are paying out of pocket. You also understand that each additional 15 minutes spent in your appointment will be an additional fee of $25.

    By initialing below you understand that if you fail to settle your account after the 120 day allotment period, you will be handed over to collections. You also understand that interest may be charged for late payments over 120 days.

    By initialling below you understand that a 10% late fee will be assessed monthly on any unpaid balance of 30 days or more. You also understand that fees are subject to change with a 30-day in-office and website notice.

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    Cancellation Policy

    Once an appointment is scheduled, that time is reserved exclusively for you. If you are unable to make the appointment, you must provide at least 24 hours advance notice so that you will not be charged the cancellation fee of $50, and so that the time may be made available to someone else. We will waive that fee in the case of emergencies (e.g., death in the family, contagious illness, unsafe driving conditions).  Please note we will not make exceptions for situations such as lack of babysitters, forgotten appointment, or a sudden business meeting.

    If you cannot make your appointment and are unable to provide the required 24 hours notice, telehealth sessions may be used in lieu of your in-person session time to keep the continuity of treatment and to prevent you from being charged for unused appointment hours. If your insurance does not cover your in person sessions the same way they would cover telehealth sessions, you will be responsible for any co-pays, coinsurances, or deductibles. You will need to contact the office in advance to schedule a telehealth session.

    If you cannot make your appointment and you are able to reschedule within the same week you are currently scheduled for, the fee will be waived. If you are not able to reschedule within the same week of your appointment, you will be responsible for $50.

    If you do not show up for your appointment then you will be charged $50. We will waive that fee in the case of emergencies (e.g., death in the family, contagious illness, unsafe driving conditions). Please note we will not make exceptions for situations such as a lack of babysitters, a forgotten appointments, or a sudden business meeting.

    You will be responsible for paying this fee before you are able to schedule another appointment. If you already have another appointment scheduled in the future then you must settle your account before meeting with your provider.

     In case of inclement weather, please call the office voicemail the morning of your appointment and listen for an outgoing message regarding the office opening. 

    By initialling below you are indicating that you have read and understood that missed appointments or appointments not canceled at least 24 hours in advance will be charged a cancellation fee of $50.

    By initialling below you are indicating that you understand you must pay the $50 late cancellation or no show charge prior to being rescheduled with your dietitian. You also understand that if you already have an appointment scheduled in the future with your dietitian that you will settle your account before meeting with them.

    By initialling below you are indicating that you understand we only waive the late cancellation fee and no show fee in the case of emergencies (e.g., death in the family, contagious illness, unsafe driving conditions). Please note we will not make exceptions for situations such as lack of babysitter, forgotten appointment, or a sudden business meeting.

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