I expressly authorize Sheila Zarfati Nutrition to contact my insurance company, health plan administrator, benefits provider, physician offices, healthcare providers, pharmacies, laboratories, and related entities on my behalf for purposes including, but not limited to:

• Verifying insurance eligibility and benefits;
• Determining coverage for nutrition counseling and medical nutrition therapy services;
• Submitting claims, appeals, referrals, prior authorizations, and supporting documentation;
• Requesting claim status updates, payment information, and explanation of benefits;
• Discussing diagnoses, treatment recommendations, and medically necessary services relevant to insurance coverage;
• Resolving billing or reimbursement issues.

I understand that the Practice may disclose the minimum necessary information required to carry out these purposes.