Your appointment time is reserved just for you. To secure your appointment we require a valid credit card number to hold your appointment.
Your credit card number will be stored in our secure credit card vault hosted by PayFirma and is heavily encrypted.
You may call into our office (204-792-1893) to give us your credit card number, or our office manager will call you to obtain it.
Your appointment is not fully booked in our system until we have a credit card on file.
Your credit card will not be charged until the time of your appointment, and if you choose to use an alternate form of payment you can do so. We accept, cash, cheque, e-transfer in addition to credit card payments.
A late cancellation or missed visit leaves a hole in the dietitians’ day that could have been filled by another client. As such, we require 24 hours notice for any cancellations or changes to your appointment. Clients, who provide less than 24 hours notice, or miss their appointment, may be charged a cancellation fee of $45.
All appointments must be cancelled via phone at 204-792-1893.
INFORMED CONSENT FORM & TERMS FOR NUTRITIONAL COUNSELING
I am hiring the counselling/consulting services of A Little Nutrition Registered Dietitians (RD). The appointment will provide information and guidance about health factors within my own control: my diet, nutrition, and lifestyle in order to nourish and support my health and wellness.
I understand that A Little Nutrition employs Registered Dietitians (not a medical physician) and does not dispense medical advice, nor will they diagnose or treat any medical condition.
I understand nutrition counselling is not a substitute for the diagnosis, treatment, or care of disease by a medical provider, but will provide nutritional support and nutrition education for an already diagnosed condition.
Rather, they provide education to enhance my knowledge of health as it relates to foods, dietary supplements, and behaviours associated with eating. While nutritional support can be an important compliment to my medical care, I understand these services are not a substitute for medical care.
I understand that A Little Nutrition will keep chart notes as a record of our work together. These notes document the topics that we talk about, interventions used, and treatment plan or any other considerations that may be helpful to your work with me.
Records will be stored in an encrypted online system designated for work. Medical records, personal information and history divulged in session to the dietitian will be kept strictly confidential unless I consent to sharing my medical and nutritional information with collaborating practitioners.
Electronic systems used for teleconferencing will incorporate network and software security to protect the confidentiality of the client. I understand that the benefits and risks from telemedicine, including, but not limited to, the possibility, despite reasonable efforts on the part of my dietitian, that the transmission of my medical information could be disrupted or distorted by technical failures; the transmission of my medical information could be interrupted by unauthorized persons; and/or the electronic storage of my medical information could be accessed by unauthorized persons.
In order to benefit from nutrition counselling, I realize that it is important for me to inform my physician or A Little Nutrition of any changes I make in the application of my diet. It is my responsibility to report any side effects or problems immediately and to make the necessary adjustments to my treatment plan with my physician and/ or A Little Nutrition. I will not hold A Little Nutrition responsible for any complications that result from my failure to comply with either of the above.
I agree to hold A Little Nutrition & its staff harmless for claims or damages in connection with our work together. This is a contract between myself and A Little Nutrition and I understand that it is also a release of potential liability.
A Little Nutrition – Medical Insurance Billing Service and Policy
Increasing access to dietitian services is our passion. Therefore, we are pleased to offer a Direct Billing Program at A Little Nutrition. Direct billing medical insurance plans is a courtesy we offer our clients, and is not a mandatory program. We offer this service free of charge, in order to make your experience more enjoyable.
We will try to directly bill only to those companies that may allow for it and for those policies that will pay the health care provider directly.
PLEASE NOTE: Everyone’s medical insurance policy is different. In some cases, your insurance provider may not allow the clinic to be paid directly or assignment of benefits. In this case, you will be asked to pay for your session in full. We will issue you a receipt for you to submit your claim to your insurance provider. You will then receive reimbursement directly from your insurance company.
How does the Direct Billing Program work?
1. Submit your insurance policy number/ID to our office via our online intake form, emailing us at email@example.com or calling us at 204-515-7466
2. We will look into your insurance coverage, and let you know the details of your coverage. Please note that everyone’s insurance plan is different and you may require to obtain a doctor’s note for coverage, or have a deductible that you need to pay.
- We will check into your coverage for dietitian services for you. However clients are responsible to ensure their benefit plan does cover services by a registered dietitian & whether or not a doctor’s note is required.
- If you require a doctor’s note, and don’t have one at the time of your appointment, you will have 2-weeks to send it to us, or we will have to take full payment for your session. You can submit your claim once you have obtained a doctors note. You can get one easily from any of our Walmart medical clinics as a walk-in patient. They can fax it to our office, as our referral form is set up in their computer system. See office locations for a clinic near you.
- If you are covered by your own insurance as well as a spouse/partner’s plan, the insurance rules are that you must claim against your own plan 1st until it’s used up and then you can claim on the alternate plan.
IMPORTANT: In order for us to be able to direct bill for you we require a Visa or MasterCard number to be held on file.
If we encounter a problem with your billing, we never charge your card automatically. Sometimes the insurance company pays the client instead of our client, loses a claim or denies a claim.
We first call you and the insurance company to rectify the situation and only charge the card as a last resort, but not before speaking with you – the cardholder. Thanks for your understanding!
Facts about Direct Billing:
Will I need to pay anything?
Some insurance plans do not cover the full amount of our dietitian service fee. If this is the case, you will pay the portion of the nutrition session cost that the insurance company doesn’t pay. For example, if you have coverage for 80% of your $125 visit fee, you will pay $25. Your insurance company will pay the remaining $100 to the clinic. Payment amounts depend on your individual coverage. There may also be a deductible that you have to pay before coverage begins.
Can I use direct billing to prepay for future appointments?
No, we can only direct bill for appointments that already took place.
Why do Insurance companies provide different coverage for their members?
Each plan is individual to the member. Insurance companies can have many different plans. For example, we have seen Blue Cross cover as little as 10% of sessions and up to 100% coverage.
What if my plan covers 100%?
Yay! You won’t have to pay anything!
Please note: In order for us to be able to direct bill for you we do require a Visa or MasterCard number to be held on file.
What if I have several insurance plans? Can you help coordinate them?
We will only direct bill to one insurance company at a time. For example, if you have 2 Blue Cross plans, then we can coordinate benefits for you. However, if you have a primary plan with Blue Cross and a secondary plan with Great West Life, then unfortunately, we do not offer any coordination of benefits. You will have to submit your receipt for the balance of the nutrition session cost to the other plan provider on your own.
Do I get a receipt if you direct bill for me?
You will get a receipt only for the portion that you pay. For example, if you have 100% coverage, you will not get a receipt. If you have 80% coverage, you will get a receipt for the 20% remaining balance that you pay.
Do insurance companies pay for missed appointment charges?
No, insurance companies do not cover missed appointment charges.