Policies

COMMUNICATION GUIDELINES

I understand that in between sessions, from initial to follow-up sessions, questions may arise.  

·  Any communication (whether it be via email, text, phone call, video call, chat, etc.) between myself, the client, and the provider, Healthy Bites NY RD, LLC, will be charged $50 per < 15 minutes for their services.  

·  At the end of the month, I will be billed for these extra small blocks of time.  This is not billable to my insurance provider.

·  If I have any “yes/ no” questions, they are allowed, with further details explained in my next session, or subject to a billable invoice.  

·  Healthy Bites NY RD, LLC will reply to any communication at their earliest convenience.

CONSENT FOR TELEHEALTH

This form describes Healthy Bites NY RD, LLC’S Telehealth treatment and payment policies and includes: 

·  Your consent to receive treatment from Healthy Bites NY RD, LLC (and your other rights and responsibilities); 

·  Your agreement to receive services using telehealth technology; and 

·  Your agreement to pay in full any charges that are your responsibility. 

·  If I am signing on behalf of a minor, incapacitated or otherwise legally dependent patient, I certify that I am a person with legal authority to act on behalf of the patient, including the authority to consent to medical services, and I accept financial responsibility for services rendered. 

1.  I agree to receive telehealth services. Telehealth involves the delivery of health care services, including assessment, treatment, and education, using interactive audio, video, and data communications. During my visit, my Healthy Bites NY RD, LLC provider and I will be able to see and speak with each other from remote locations. 

2.  I understand and agree that: 

·  I will not be in the same location or room as my provider. 

·  Healthy Bites NY RD, LLC uses secure email to send important post-visit and treatment-related information. I will provide Healthy Bites NY RD, LLC with a valid email address during registration. 

·  My provider is licensed in the state in which I am receiving services. I will report my location accurately during registration. 

·  Potential benefits of telehealth (which are not guaranteed or assured) include: access to care, more efficient evaluation and management and reduced exposure to patients, medical staff and other individuals at a physical location. 

·  Potential risks of telehealth include: delays in evaluation and treatment due to technical difficulties or interruptions, distortion of images resulting from electronic transmission issues, unauthorized access to my information, or loss of information due to technical failures. I will not hold Healthy Bites NY RD, LLC responsible for lost information due to technological failures. 

·  I further understand that advice, recommendations, and/or decisions may be based on factors not within his/her control, including incomplete or inaccurate data provided by me. I understand that my provider relies on information provided by me before and during our telehealth encounter and that I must provide information about my medical history, condition(s), and current or previous medical care that is complete and accurate to the best of my ability. 

·  I may discuss these risks and benefits with my provider and will be given an opportunity to ask questions about telehealth services. I have the right to withdraw this consent to telehealth services or end the telehealth session at any time without affecting my right to future treatment by Healthy Bites NY RD, LLC. 

·  I understand that the level of care provided by my provider is to be the same level of care that is available to me through an in-person visit. However, if my provider believes I would be better served by face-to-face services or another form of care, I understand that my provider may direct me to visit a health care provider and agree to follow that advice. 

·  I have the right to receive face-to-face services at any time by traveling to a Registered Dietitian that is convenient to me.  

3. I consent to, understand and agree that: 

·  I have the right to discuss the risks and benefits of all treatment proposed by my health care provider(s), together with any available alternatives. 

·  Healthy Bites NY RD, LLC will provide care consistent with the prevailing standards of care but makes no assurances or guarantees as to the results of treatment.  

·  I have the right to review and receive copies of my medical records, including all information obtained during a telehealth interaction, subject to Healthy Bites NY RD, LLC’s standard policies regarding request and receipt of medical records and applicable law. 

·  The laws of the state in which I am located will apply to my receipt of telehealth services. 

PRIVATE POLICY

Healthy Bites NY RD, LLC will protect the privacy of my health information and will not use or disclose it except as permitted by law. I understand that all existing confidentiality protections that apply to in-person treatment apply to telehealth services. 

CANCELLATION AND NO-SHOW POLICIES

We understand that you may need to cancel an appointment occasionally. In such circumstances, please contact us no later than 24 hours before your scheduled appointment time. You may do so by contacting Healthy Bites NY RD, LLC via phone, email, or website.  If you do not show up for your appointment, or cancel or reschedule within 24 hours of your appointment time, we will consider that a no-show. No-show appointments may be subject to a $85 fee. No-show fees are the patient’s sole responsibility and must be paid in full before your next appointment. 

We know that unexpected situations sometimes arise. In the case of emergencies or extenuating circumstances, we may waive the no-show fee. Waivers are determined on a case-by-case basis at the practice management's sole discretion. 

If our office must cancel your appointment with less than 24 hours notice, you may choose to meet with a different provider (if available) on the same day, to reschedule, or to cancel. In these circumstances, we will not charge you a cancellation fee.

PAYMENT POLICY

I acknowledge, understand and agree that:

1.  I assign to Healthy Bites NY RD, LLC all health care benefits to which I am entitled under any insurance policy or benefit plan and authorize payment of benefits directly to Healthy Bites NY RD, LLC. 

2.  If I have health care benefits, Healthy Bites NY RD, LLC will submit a claim to my insurer and allow 60 days for a response. If my insurer does not respond within 60 days, Healthy Bites NY RD, LLC will assume that the visit is not covered and will, to the extent permitted by law, bill me for the visit charges.  

3.  I understand that I am personally responsible to pay for my care, if I do not have insurance, or my insurance does not pay for my care because:

·  My insurance requites a referral from my primary physician before seen, and I did not get a referral.

·  My health plan denies payment for these services and leaves me responsible for payment

·  My insurance decides that these services are not medically necessary and/or not covered.

·  My health plan coverage has lapsed or expired at the time I receive services.

·  I have chosen not to use my health insurance plan.

I understand you may be required by law to bill my spouse or parent if I am receiving public assistance from the government.

4.  By providing my credit card information and receiving telehealth services, I authorize Healthy Bites NY RD, LLC to charge my credit card for any and all unpaid amounts that Healthy Bites NY RD, LLC or my insurer determines are my responsibility, and agree to pay all amounts charged pursuant to this consent and authorization in accordance with the issuing bank cardholder agreement. I agree that Healthy Bites NY RD, LLC may charge my credit card for such amounts at the end of my telehealth visit or at a later date. 

5.  I will be billed for all unpaid balances deemed by Healthy Bites NY RD, LLC or my insurer to be my responsibility and agree to pay such amounts in full. Healthy Bites NY RD, LLC will charge late fees of 1.5% per month on unpaid balances starting 30 days after the first statement, as well as a $30 fee for returned checks. Delinquent accounts may be turned over to a collection agency at which time I am responsible for a $40 collections charge and all associated legal fees in addition to the amount owed. 

6.  Healthy Bites NY RD, LLC reserves the right to deny services if my account is delinquent. 

7.  We DO NOT DISCRIMINATE, NOR WILL WE TOLERATE PREJUDICES against any person on the basis of age, race, ethnicity, language, national origin, socioeconomic status, mental or physical ability, religion, sex, sexual orientation, gender identity in treatment or participation in our programs, services, or activities.  Healthy Bites NY RD, LLC reserves the right to deny services if we feel this has been violated.