No Surprises Act & Good Faith Estimate Notice
For Clients Receiving Nutrition Services
As of January 1, 2022, you are protected by the No Surprises Act, a federal law that helps prevent unexpected medical bills. This includes nutrition therapy services provided by Liberated Plate Nutrition Therapy, especially for those seeking support with eating disorders.
Who Is Covered?
This notice applies to clients who:
Your Right to a Good Faith Estimate
You are entitled to receive a Good Faith Estimate (GFE) explaining the anticipated cost of your nutrition care before you receive services. In our practice, eating disorder nutrition care may include:
You can receive a written GFE upon request, outlining the estimated total cost for a recommended course of care based on your unique needs.
Please note: Eating disorder recovery is a highly individualized process and timelines may vary. The GFE will reflect services that are reasonably expected at the time it is provided, but adjustments may occur as treatment progresses.
Disputing Unexpected Charges
If you receive a bill that is $400 or more above the Good Faith Estimate, you have the right to dispute the charge.
You may:
Contact hello@liberatedplate.co to discuss your bill
File a dispute with the U.S. Department of Health and Human Services (HHS)
Dispute requests must be submitted within 120 days of receiving the bill. Learn more about this process at:
https://www.cms.gov/nosurprises
đź“© Questions?
We’re happy to provide a Good Faith Estimate at any time. Just contact us at hello@liberateplate.co.
As of January 1, 2022, you are protected by the No Surprises Act, a federal law that helps prevent unexpected medical bills. This includes nutrition therapy services provided by Liberated Plate Nutrition Therapy, especially for those seeking support with eating disorders.
Who Is Covered?
This notice applies to clients who:
- Are uninsured, or
- Are not using insurance (self-pay) for services
Your Right to a Good Faith Estimate
You are entitled to receive a Good Faith Estimate (GFE) explaining the anticipated cost of your nutrition care before you receive services. In our practice, eating disorder nutrition care may include:
- Comprehensive initial assessments
- Ongoing follow-up sessions
- Meal planning support
- Coordination with your care team (therapist, physician, etc.)
You can receive a written GFE upon request, outlining the estimated total cost for a recommended course of care based on your unique needs.
Please note: Eating disorder recovery is a highly individualized process and timelines may vary. The GFE will reflect services that are reasonably expected at the time it is provided, but adjustments may occur as treatment progresses.
Disputing Unexpected Charges
If you receive a bill that is $400 or more above the Good Faith Estimate, you have the right to dispute the charge.
You may:
Contact hello@liberatedplate.co to discuss your bill
File a dispute with the U.S. Department of Health and Human Services (HHS)
Dispute requests must be submitted within 120 days of receiving the bill. Learn more about this process at:
https://www.cms.gov/nosurprises
đź“© Questions?
We’re happy to provide a Good Faith Estimate at any time. Just contact us at hello@liberateplate.co.
