Good Faith Estimate

Under the federal No Surprises Act, you have the right to receive a “Good Faith Estimate” explaining how much your care may cost. This applies if you are uninsured or if you choose not to use your health insurance (self-pay). Well Said Well Fed Speech Therapy Services is a private-pay, out-of-network practice, so this right applies to the families I work with.

Your Right to a Good Faith Estimate

If you are uninsured or paying out of pocket, you have the right to receive a Good Faith Estimate of the expected charges for your child’s evaluation and therapy services. This includes an estimate of the cost of the services I reasonably expect to provide.

• You can ask me for a Good Faith Estimate before you schedule any service.
• I will also provide a Good Faith Estimate when you schedule care.
• You have the right to receive the estimate in writing.

What the Estimate Reflects

A Good Faith Estimate reflects the services I reasonably expect to provide and their expected charges at the time the estimate is prepared. Pediatric feeding and speech-language care is individualized, so please know that a Good Faith Estimate is an estimate, not a final bill or a set treatment plan.

Because so much depends on what I learn from your child, the actual recommendations, recommended frequency, duration of care, and charges may change based on:

• What I find during the evaluation
• Your child’s clinical needs and progress over time
• Scheduling and how care is delivered

If my recommendations change in a way that affects your expected costs, I’m glad to talk it through with you and provide an updated estimate.

How to Request an Estimate

You can request a Good Faith Estimate at any time by reaching out through my contact page. A few things to know about timing:

• If you request an estimate for care that is not yet scheduled, I will provide it within 3 business days of your request.
• If you schedule a service at least 3 business days in advance, I will provide an estimate within 1 business day of scheduling.
• If you schedule a service at least 10 business days in advance, I will provide an estimate within 3 business days of scheduling.

If Your Bill Is Higher Than Your Estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate for a given provider, you have the right to dispute the bill through the federal patient-provider dispute resolution process. You must start the dispute process within 120 calendar days of the date on your bill.

Starting a dispute will not affect the quality of care you receive from me. Make sure to save a copy of your Good Faith Estimate so you can compare it to any bills you receive.

An Estimate Is Not a Guarantee or an Obligation

A Good Faith Estimate is not a contract, and it does not require you to move forward with any services. It also does not guarantee any particular treatment outcome. You are always free to ask questions, take time to decide, or choose not to proceed.

Questions or More Information

If you have questions about a Good Faith Estimate for your family, please reach out through my contact page and I’ll be glad to help.

For more information about your rights under the No Surprises Act, or to learn about the dispute resolution process, visit www.cms.gov/nosurprises or call the federal Help Desk at 1-800-985-3059.