No Surprises Act

Effective: January 1, 2025

The No Surprises Act, effective January 1, 2022, is designed to offer consumer protection against unexpected medical bills. This Act requires all state-licensed and certified health care providers to issue a Good Faith Estimate of the cost of their health care services to uninsured and/or self-pay (out of pocket) clients prior to services being rendered. Note: this estimate is not a bill and you are not obligated to obtain any of the services listed below.

Details of Service for Cascade Nutrition

Entity: Cascade Nutrition, PLLC (EIN 33-1894299, NPI: 1467269555)

Provider: Anna Estes, MPH, RDN, CD (NPI 1326634130)

Service: Medical Nutrition Therapy, Nutrition Counseling, Nutrition Coaching

Diagnosis Code (ICD-10-CM): Z71.3, Dietary Counseling and Surveillance; may vary per client depending on individualized client needs and care plan

Service Code: 97802, 97803

Quantity: Variable, depending on appropriate frequency of client sessions as determined by clinician and client. Some clients may be seen a few times, whereas other clients may be seen on an ongoing basis for >1 year. For the purpose of the Good Faith Estimate, assumed frequency of client sessions is 1 session per week for 1 year (~52 weeks).

Cost Per Session (self pay rates): Initial session $200, Follow up session $180

Total Expected Cost of Services from Cascade Nutrition (self pay rates): $9,380 per year, assuming 1 initial assessment, (60 minutes), then 1 follow up session (45-60 minutes) per week for 52 months.

Insurance

If Cascade Nutrition is in-network with your insurance plan, your out-of-pocket costs will depend on your copay, coinsurance, and deductible. You are responsible for paying any amounts that are not covered or payable by your insurance, such as your copay and coinsurance. If your insurance plan denies a claim due to non-coverage of diagnosis or session limit, you are responsible for paying the full cost of sessions as outlined above. 

Disclaimer

This Good Faith Estimate shows the costs of items and services that may be reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created, and does not include any unknown or unexpected costs that may arise during treatment.

Right to Dispute

If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. Throughout your treatment, your provider may recommend additional resources, items or services as part of your treatment that are not reflected in this estimate. These would be discussed separately with your consent and the understanding that any additional service costs are in addition to the Good Faith Estimate.

If your needs change during treatment, your provider should supply a new, updated Good Faith Estimate to reflect the changes to treatment, and the accompanying cost changes.

You may contact the health care provider or facility listed 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.

The Good Faith Estimate is not a contract between provider and client and does not obligate or require the client to obtain any of the listed services from the provider.

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 HHS at (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 (800) 985-3059.

Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed a higher amount.