Good Faith Estimate notice

Your right to a Good Faith Estimate

You have the right to receive a Good Faith Estimate explaining how much your child’s care will cost.

Under the federal No Surprises Act, health care providers must give people who are not using insurance a written estimate of expected charges before care begins. You can ask for one at any time, and we will give you one when you schedule care.

Keep your estimate. You will need it if a bill ever comes in much higher than expected.

Who this applies to at KidSLP

Everyone. KidSLP is a private-pay practice. We do not bill insurance, so every family we work with counts as “self-pay” under this law and has the right to a Good Faith Estimate.

This is still true if you plan to seek reimbursement on your own. Some families ask us for a monthly superbill to submit to their health plan for possible out-of-network reimbursement. That does not change anything here — you still get a Good Faith Estimate, because we are not billing your plan.

You do not have to do anything to earn this right, and asking for an estimate will never affect how we care for your child.

What the estimate includes

Your Good Faith Estimate will list:

• Your child’s name and date of birth
• A plain-language description of the service being scheduled
• An itemized list of the services we reasonably expect to provide, with the expected charge for each
• The diagnosis and service codes that go with each item
• Our name, National Provider Identifier, Tax ID, and the state and location where care will happen
• Anything we expect your child may need that has to be scheduled separately, and how to get an estimate for that too

If your child is starting ongoing therapy, we can issue one estimate covering a course of care — including how often sessions are expected and how many. By law, that kind of estimate can cover up to 12 months. If care continues past that, or if the plan changes, we will send you a new estimate.

A Good Faith Estimate is an estimate, not a bill and not a contract. It reflects what we reasonably expect at the time we write it. Actual services and charges can differ, and you are never required to receive care from us.

When you get one

• If you schedule at least 3 business days ahead: we give you the estimate in writing within 1 business day after scheduling.
• If you schedule at least 10 business days ahead: we give you the estimate in writing within 3 business days after scheduling.
• If you just ask, before scheduling anything: we give you the estimate in writing within 3 business days of your request.

Business days are Monday through Friday, not counting federal holidays.

If care is scheduled fewer than 3 business days out, the law does not require an estimate — but you can still ask, and we will do our best. If anything about the plan changes before the appointment, we will send you an updated estimate.

You can have your estimate on paper or electronically, whichever you prefer.

If your bill is much higher than the estimate

If you get a bill from us that is at least $400 more than the expected charges on your Good Faith Estimate from us, you can dispute the bill through a free federal process called patient-provider dispute resolution. An independent reviewer looks at the estimate and the bill and decides what you should pay.

A few things to know:

• You must start the dispute within 120 calendar days of the date on your first bill.
• There is a $25 administrative fee to start the process. If the reviewer decides in your favor, that amount is taken off what you owe.
• You need a written Good Faith Estimate to use this process. That is one more reason to save yours.
• Starting a dispute will never affect the quality of care your child receives here.

To start a dispute or read more, go to www.cms.gov/nosurprises or call 1-800-985-3059.

You can also just talk to us first. If a bill looks wrong to you, email us and we will look at it with you.