You can always press Enter⏎ to continue
Wellory: Qualification Survey
  • 1
    We'll use this to contact you about your eligibility to meet with an in-network dietitian.
    Press
    Enter
  • 2
    Please write your full name as it appears on your insurance card.
    Press
    Enter
  • 3
    Your physical location determines which of our providers are eligible to support you.
    • Alabama
    • Alaska
    • Arizona
    • Arkansas
    • California
    • Colorado
    • Connecticut
    • Delaware
    • District of Columbia
    • Florida
    • Georgia
    • Hawaii
    • Idaho
    • Illinois
    • Indiana
    • Iowa
    • Kansas
    • Kentucky
    • Louisiana
    • Maine
    • Maryland
    • Massachusetts
    • Michigan
    • Minnesota
    • Mississippi
    • Missouri
    • Montana
    • Nebraska
    • Nevada
    • New Hampshire
    • New Jersey
    • New Mexico
    • New York
    • North Carolina
    • North Dakota
    • Ohio
    • Oklahoma
    • Oregon
    • Pennsylvania
    • Rhode Island
    • South Carolina
    • South Dakota
    • Tennessee
    • Texas
    • Utah
    • Vermont
    • Virginia
    • Washington
    • West Virginia
    • Wisconsin
    • Wyoming
    • I'm outside the USA
    Press
    Enter
  • 4
    Press
    Enter
  • 5
    Press
    Enter
  • 6
    Please select your primary health insurance.
    • Aetna
    • Blue Cross Blue Shield
    • Cigna
    • Emblem Health
    • Healthfirst
    • Healthpass
    • Humana
    • Medicare
    • Medicare Advantage
    • Medicaid
    • MVP
    • Oxford
    • Oscar
    • United Health Care
    • Other
    • I don't have health insurance
    Press
    Enter
  • 7
    Please select your primary health insurance.
    • Aetna
    • Blue Cross Blue Shield
    • Cigna
    • Emblem Health
    • Healthfirst
    • Healthpass
    • Humana
    • Medicare
    • Medicare Advantage
    • Medicaid
    • MVP
    • Oxford
    • Oscar
    • United Health Care
    • Other
    • I don't have health insurance
    Press
    Enter
  • 8
    Press
    Enter
  • 9
    Press
    Enter
  • 10

    Great news!

    Most Aetna plans offer 100% coverage for 10 nutrition sessions per calendar year with a Wellory provider if you have a qualifying diagnosis. Please note, a doctor’s referral will be required. 

    Click “Next” to see if you qualify. 

    Our team is here to help! Answer the next few questions to determine what’s included in your plan.

    If you have a deductible, co-pay or co-insurance, an out-of-pocket cost may apply. You may use your HSA/FSA funds for any applicable fees. We will always let you know if a fee applies prior to your visit.

    Press
    Enter
  • 11
    Press
    Enter
  • 12
    You can find this information on the front of your insurance card.
    • PPO
    • HMO
    • POS
    • Open Access
    • Open Access Plus
    • LocalPlus
    • EPO
    • HDHP
    • Other
    Press
    Enter
  • 13
    You can find this information on the front of your insurance card.
    Press
    Enter
  • 14
    You can find this information on the front of your insurance card.
    Press
    Enter
  • 15
    Press
    Enter
  • 16
    Your birthdate allows us to verify your insurance benefits.
    -
    Pick a Date
    Press
    Enter
  • 17
    By submitting this form, you are opting into email communication with Wellory.
    Press
    Enter
  • 18
    Press
    Enter
  • 19
    Press
    Enter
  • 20

    Great news! 

    Most Cigna plans offer 100% coverage for at least 3 nutrition counseling sessions per calendar year with a Wellory provider. These visits are billed as a preventative service, with no doctor’s referral required.

    Click “Submit” to choose your provider!

    If you have a deductible, co-pay or co-insurance, an out-of-pocket cost may apply. You may use your HSA/FSA funds for any applicable fees. We will always let you know if a fee applies prior to your visit.

    Press
    Enter
  • 21

    Great news! 

    Most Cigna plans offer 100% coverage for at least 3 nutrition counseling sessions per calendar year with a Wellory provider. These visits are billed as a preventative service, with no doctor’s referral required.

    However, the state of California requires a doctor referral in order to book your initial consultation.  

    Click “Submit” for instructions on how to obtain your physician referral in 1 easy step (under 2 mins!) 

    If you have a deductible, co-pay or co-insurance, an out-of-pocket cost may apply. You may use your HSA/FSA funds for any applicable fees. We will always let you know if a fee applies prior to your visit.

    Press
    Enter
  • 22

    You qualify for in-network nutrition care through Aetna!

    Please click “Submit” for instructions on how to obtain your doctor referral in 1 easy step (under 2 mins!)

    Press
    Enter
  • 23

    Because you do not have a qualifying diagnosis, Aetna will not cover the cost of your nutrition care at this time.

    You can instead take advantage of our out-of-pocket rates or use your HSA or FSA funds for Wellory sessions!

    $150 per 1-hour initial session
    $75 per follow-up session

    If you'd like to pay out-of-pocket or use your HSA/FSA funds for your first session, click “Submit” to choose a provider!

    Note: Under “Reason for Appointment” you may detail whether you’d like to pay out-of-pocket or use HSA/FSA funds.

    Press
    Enter
  • 24

    We don’t have any in-network providers available to support you at this time.

    You can instead take advantage of our out-of-pocket rates or use your HSA funds for Wellory sessions!

    $150 per 1-hour initial session
    $75 per 30-minute follow-up session

    If you'd like to pay out-of-pocket or use HSA funds for your first session, click “Submit” to choose a provider!

    Note: Under “Reason for Appointment” you may detail whether you’d like to pay out-of-pocket or use HSA funds.

    A Superbill may be provided at your request so that you may submit for any reimbursement available by your insurance. 

    Press
    Enter
  • 25

    You’re eligible for our discounted out-of-pocket rates!

    $100 per 1-hour initial session (value: $150)
    $50 per 30-minute follow-up session (value: $75)

    If you’d like to take advantage of our discounted out-of-pocket rates, click “Submit” to choose a provider.

    Please select the “Self-Pay” session type when booking to receive the discounted rate!

    Press
    Enter
  • Should be Empty:
hipaa badge
Question Label
1 of 25See AllGo Back
close