Good Faith Estimate.
Effective Date: April 17th 2024
Brief explanation of estimate for new clients: The estimate below is the range of costs that is typical for most new clients. Until an initial evaluation is conducted, we will not have a clear picture of your specific diagnosis, concerns and needs. Typically see clients for 3-20 sessions for an estimated cost of $485-$3035, based upon your dietitian’s rate. But in some cases a client’s condition may be more complicated, so we may need additional sessions during the time covered by this estimate.
Brief explanation for continuing clients: The estimate below is the range of costs that is likely for your care over the time period covered by this estimate. However, depending on how treatment progresses, more or fewer sessions may be needed.
Contact: If you have questions about this estimate, please contact our Practice Manager who can answer questions about the Good Faith Estimate at 707-200-1178 x2 or info@areyouarenutrition.com.
Details of the Estimate: The following is a detailed list of expected charges based upon your dietitian’s rate for medical nutrition therapy services for up to 6 months. The estimated costs are valid for 6 months from the date of this Good Faith Estimate, unless we send you an updated estimate.
Initial Assessment = $185
12 weeks of service (approx. 3 months) = $1800 for weekly sessions, $900 for biweekly sessions
26 weeks of service (approx. 6 months) = $3900 for weekly sessions, $1950 for biweekly sessions
Disclaimer: This Good Faith Estimate shows the costs of services that are reasonably expected for the expected services to address your medical nutrition therapy needs. The estimate is based on the information As You Are Nutrition Inc has gathered from previous clients. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.
You may contact the Practice Manager at the contact listed above to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.
You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.
There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
To learn more and get a form to start the process, go to: www.cms.gov/nosurprises or call CMS at 1-800-985-3059.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call CMS at 1-800-985-3059 .
This Good Faith Estimate is not a contract. It does not obligate you to accept the services listed above.