Good Faith Estimate
A ruling titled the “No Surprises Act” went into effect January 1, 2022, requiring professionals to provide a “Good Faith Estimate” (GFE) to those not using insurance and/or utilizing self-pay. A Moment of Change is 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 cost of services. Note that this is based on the time at which the GFE was created. In the event of a change, and 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 allowed by federal law to appeal/dispute the bill if the client and provider have not had a prior discussion about a change and the client has not been given a revised GFE. This estimate is meant to provide transparency regarding expected medical expenses. It is based on what is reasonably expected for your health care needs, diagnosis(es), and reason for seeking treatment. The estimate is created with information known to your provider at the time it was created and cannot account for unexpected costs that may arise.
Diagnoses are sometimes given to guide creation of a treatment plan. Diagnostic codes may change depending on needs and treatment plan. However, a diagnosis is not a factor in determining pricing of service. The client can speak with their provider if they have any questions.
A Moment of Change recognizes an individual’s circumstance is unique. As such, frequency and duration of treatment can vary based several factors such as schedule/availability of the client and provider, specific and non-specific life circumstances, nature of clinical needs, and finances. The client and provider will work together to determine the best course of action regarding frequency of services and how to best meet therapeutic goals. The provider will also issue a revised GFE should a change occur. Ultimately, as the client, you have the right to choose whether to stay in 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 toa Good Faith Estimate, visit www.cms.gov.nosurprises or call 800-985-3059.