Good Faith Estimate
A ruling titled the “No Surprises Act” went into effect on January 1, 2022, requiring professionals to provide a “Good Faith Estimate” (GFE) to clients who are not using insurance and/or are utilizing self-pay counseling. A Moment of Change operates out-of-network and does not participate with any insurance plans. This means you are entitled to receive a Good Faith Estimate in writing with the cost of your care upfront when you schedule your first appointment. Doing so provides clients with a reasonable expectation of the cost of services. Note that this estimate is based on the information available at the time the GFE was created. In the event of any changes, an updated GFE will be provided.
The GFE does not include unexpected or unknown costs that may arise during treatment. Certain complications or circumstances could occur. In such cases, you are permitted by federal law to appeal or dispute the bill if there hasn’t been a prior discussion between the client and provider regarding a change, and if the client has not been given a revised GFE. This estimate is intended to provide transparency regarding expected medical expenses. It reflects what is reasonably anticipated for your health care needs, diagnosis(es), and reason for seeking treatment. The estimate is generated with the information known to your provider at the time it was created and cannot account for unforeseen costs that may arise.
Diagnoses are sometimes assigned to guide the creation of a treatment plan. Diagnostic codes may change depending on needs and treatment plans. However, a diagnosis does not influence the pricing of services. Clients can speak with their provider if they have any questions.
A Moment of Change recognizes that each individual’s circumstances are unique. Consequently, the frequency and duration of self-pay counseling can vary based on several factors such as the schedule and availability of both the client and provider, specific and non-specific life circumstances, the nature of clinical needs, and financial considerations. The client and provider will collaborate to determine the most effective course of action regarding the frequency of services to best meet therapeutic goals. Should a change occur, the provider will also issue a revised GFE. Ultimately, as the client, you have the right to choose whether to continue or discontinue therapy. Out of an abundance of caution, your Good Faith Estimate will project treatment for 12 months based on the current rates.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.