Good Faith Estimate from Waring Wellness
The date of this GFE is the date in which it is delivered to you through our portal or email.
The estimated costs are valid for 12 months from the date of delivery.
*We reserve the right for price increases, at which time we will notify you and provide a new GFE. Updated GFE estimates and Servis Price List/Menu is available though www.waringwellness.com
Terminology:
GFE is an acronym for Good Faith Estimate.
“You/Your” is in reference to the Patient.
“We/Our” is in reference to Waring Wellness / Kristina Waring MA CCC-SLP
“Speech Therapy” includes treatment of various voice and upper airway disorders and is in no way limited to articulation practices only
ST is an acronym for Speech Therapy
SLP is an acronym for Speech-Language Pathology or Pathologist
OON is an acronym for Out-Of-Network Provider
ASHA is an acronym for the American Speech-Language Hearing Association
Understanding your GFE
The GFE is an estimate of your healthcare costs while receiving care with a convening provider through Waring Wellness.
How does it affect me and why am I asked to sign this?
As of January 1, 2022, all licensed healthcare providers in the U.S. are required to provide estimates for the costs of your care. The GFE shows the cost of items and services that are reasonably expected for your healthcare needs and treatment. This will be provided by Waring Wellness upon scheduling and/or as requested. This GFE does not include unexpected costs that could arise during treatment.
How does this affect billing and payment policies for healthcare with Waring Wellness?
The intent of the law is to protect you from surprise billing and "unexpected surprise charges". Waring Wellness agrees to offer and maintain transparent pricing and simple billing with payment due at time of service without any surprises due after the service. Unless there is a mechanical or technological malfunction preventing us from collecting payment at the time of service, we customarily do not send patients a bill. Invoices are available in your patient portal, where you can review the services provided and payments.
Even though we do not submit bills due following services rendered, by law, we are still required to provide you with this document. We do provide you with an invoice at the time services are provided.
Costs of Services
GFE for Health Care Items and Services Under the No Surprises Act. Please refer to our website at www.waringwellness.com for detailed pricing and a listing of out-of-pocket healthcare costs with a convening provider at Waring Wellness.
Late Cancelation and No-Show Policy
Your appointment time with our specialist is reserved just for you. These fees maintain the integrity of the therapeutic relationship and encourages commitment to these appointments. They also reflect the value of the speicalist's time and expertise.
As a courtesy to other patients seeking services and our specialist, we require a 24-hour (or greater) notice for cancellations or changes to your appointment.
Late Cancellation or No-Show for a reserved 90-minute time slot or an evaluation consultation visit will result in a charge of $150.00.
Unfortunately, this fee cannot be applied to a rebooking of the appointment.
Late Cancellation or No-Show for a reserved 45-60-minute time slot used for treatment or re-evaluation will result in a charge of $50.00.
Unfortunately, this fee cannot be applied to a rebooking of the appointment.
Fee Waiver Exceptions: Cancellation and no-show fees may be waived when the cancellation or no-show occurs as the result of:
inclement weather
poor road conditions
natural disaster or state of emergency
school closures
power outages
medical and personal emergencies
Please call Waring Wellness administrator to appeal your fee for cause.
CPT Codes
CPT codes (Current Procedural Terminology) are used to identify professional services provided and to report those services in a way that can be universally understood by institutions, private and government payers, researchers, and others interested parties. In other words, CPTs are numbers that identify the type of service provided by your specialist (type of assessment v type of treatment).
Your sessions may be coded by one or more of the CPT codes listed below.
Speech Pathology Evaluation up to the first 90 minutes
Potential CPT codes could include:
92610 ($390.00): Evaluation of oral and pharyngeal swallowing function
92524 ($585.00): Behavioral and qualitative analysis of voice and resonance
31579 (390.00): Laryngoscopy; flexible or rigid telescopic, with or without stroboscopy, but with diagnostic therapeutic trials
Individual INITIAL Assessment Units: after the first 90 minutes the following pay rate will be applied to your visit.
$42.00 / 1-additional unit 8-22 minutes (e.g., 98-112 minutes)
$84 / 2-units 23-37 minutes
$126 / 3-units 38-52 minutes
$168 / 4-units 53-67 minutes (assessments will not exceed 157 minutes or 2 hours and 37 minutes)
*Maximum amount charged for a 2-hour, 37-minute initial evaluation, 1-on-1 with the specialist will not exceed the of total: $753.00
1) GFE for initial assessment with specialist for voice, cough, laryngeal dysfunction, breathing disorder: $585.00-$753.00
2) GFE for initial assessment with specialist for swallowing and choking disorder: $390.00-$558.00
Initial Assessment or Formal Evaluation will be billed once every 12 months from date of service. If you are a returning patient to this provider and have not been seen in over 12 months you qualify as “new patient” and an initial assessment will be conducted and formal plan of care generated.
Re-Assessment or Re-Evaluation Units:
A Re-Assessment or Re-Evaluation occurs when further assessment is needed before the end of the 12-month certification cycle. Skills are re-evaluated, but only if the criteria listed below are met. Please note that a 12-month certification cycle is not an indicator for how long you will “be in therapy” but is the certification period for your services.
Interestingly, Physical therapists and Occupational therapists have clearly defined CPT codes for re-evaluations. Speech language pathologists (SLPs), on the other hand, DO NOT. The fact is not all insurance carriers cover the costs of re-evaluations for SLPs, and those that do have a roundabout way of categorizing these costs. This can result in the patient being over or under charged for services rendered.
Also interesting is SLPs are limited in the types of CPT codes they can submit to insurance companies or state funded assistance programs. For example, although your pathologist may use manual therapy to manipulate the voice box or larynx (used for muscle tension dysphonia and VCD patients), the SLP cannot use the appropriate CPT code of 97140 (Manual therapy techniques) which costs $42.00 per 15-minute units. Instead, the SLP can only bill 92507 which costs $166.50 for any length of time (5 minutes or 60 minutes). In our opinion this encourages overcharging of a patient, simply because there are not enough CPT codes deemed “available” to SLPs to reflect the type of actual service. Lobbyists on behalf of SLPs are working on changing this but in the meantime, these limits remain.
If a Re-evaluations or Re-assessment is warranted and the following criteria are met, we will bill a re-evaliation under the 96110 or 96112 services for Developmental testing for fine and gross motor function. The features of voice, swallow and respiration fall within the definition of “fine and gross motor function.”
Re-assessment Criteria is as follows:
1) The therapist’s assessment points to a significant improvement, decline, or variation in the patient’s condition or functional status that was not anticipated in the plan of care for that interval
2) New clinical findings
3) The patient has failed to respond to the treatment outlined in the current plan of care
96110 ($146.25) first 45-60 minutes
Developmental screening, with interpretation and report, per standardized instrument form
96112 ($292.50) first 60 minutes
Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour
Speech Pathology Follow-Up Treatment
Potential CPT codes could include but are not limited to:
92507 ($166.50 for 1 unit up to frist 60 minutes) (on-site in-person, clinic visit; telepractice visit) Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
97530 ($177.00 for up to 60 minutes) + Dome entry fee (purchased separately) Dome Day Therapeutic Dynamic Activities are used to improve functional performance. Examples of such activities include lifting, pushing, pulling, reaching, throwing, running, etc, direct, one on one contact, per 15-minute increments
92508 ($83.25 for first 60 minutes) Treatment of speech, language, voice, communication, and/or auditory processing disorder in a group, two or more individuals.
97150 (83.25 for the first 60 minutes) all therapeutic services provided to a group of 2 or more people at the same time
92526 (166.50 for the first 60 minutes) Treatment of swallowing dysfunction and/or oral function for feeding
97110 (42.00/unit max units 4) Therapeutic Exercise to boost or maintain strength, endurance, flexibility, or range of motion
97112 ($42.00/unit max units 4) Neuromuscular re-education of movement, balance, coordinate, kinesthetic sense, posture, and/or proprioception for activities
97140 ($42.00/unit max units 4) Manual therapy techniques including mobilization/manipulation, manual traction, manual trigger point therapy and myofascial release; used to treat the restricted motion of soft tissues to increase pain-free range of motion and facilitate a return to functional activities
97533 ($42.00/unit max units 4) Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes
97129 ($42.00/unit max units 1) Therapeutic interventions that focus on compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes
97130 ($42.00/unit max units 7) Therapeutic interventions that focus on compensatory strategies to manage the performance of an activity, direct (one-on-one) patient contact; each additional 15 minutes
Individual Therapeutic Units DEFINED by length and cost:
$42.00 / 1-additional unit 8-22 minutes
$84 / 2-additional units 23-37 minutes
$126 / 3-additional units 38-52 minutes
$168 / 4-additional units 53-67 minutes
Diagnosis
The No Surprises Act and Good Faith Estimate regulations ask that we provide a diagnosis on this form. We do not typically diagnose patients unless we believe a specific diagnosis to be accurate and after careful consideration, assessment, and consultation with the patient. We are ethically obligated to only diagnose after a thorough evaluation, assessment, and discussion with you and/or your medical team.
We reserve the right to defer diagnosis until we can thoroughly assess your case, conduct an appropriate evaluation, and discuss treatment planning with you and your medical team.
Therefore, the current diagnosis for the purpose of this document may not be identified. In this instance, the reason for referral from your prescribing care provider may be used. Unless a diagnosis is corroborated, expanded or clarified by the specialist, the term “diagnosis” used in this context is used as reference for the purpose of this GFE. The actual or confirmed diagnosis determined after the inital evaluation may differ from that offered on this GFE.
If you actual diagnosis and the GFE are different you will be provided with written revision of your GFE at your request. To simplify this process, most diagnosis have already been identified on this document. The amounts for each diagnosis grouping have also been indentified. In other words, if you provider referred you for a voice evaluation, but during the evaluation we identify that a functional swallow assessment is more appropriate, your GFE will identied at that time as services pertaining to swallow and not to voice. The price listing established identifies these estimates. Therefore other then noting we had this discussion, providing you this documentation is repetitive. We are of course happy to write something more specific and clarifying at your request.
Estimated Charges based on average number of treatments:
We anticipate you will require the average number of treatment sessions listed below, as determined by your actual diagnosis:
VCD non exercise related 4-5 visits + 1 evaluation
VCD or EILO exercise related 5-7 visits (4 visits with exercise challenges) + 1 evaluation
Voice disorder 7-14 visits +1 evaluation
Chronic cough or throat clearing 4-5 visits + 1 evaluation
Choking, apnea or functional swallowing disorder 3-5 + 1 evaluation.
The number of visits appropriate in your case, and the estimated cost for those services will depend on your needs and what you agree to in consultation with your speech pathologist. This estimate could change depending on your individual condition and your progress during treatment.
Additional visits or services could be recommended at any point during your care. We can discuss any potential changes and you may request an updated Good Faith Estimate.
This Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of sessions with your speech pathologist or specialist.
You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time.
This GFE is not a contract and does not obligigate you to obtain any services from the provider(s) listed, nor does it include any services rendered to you that are not identified here.
If you participate in a listed service, you must pay for the listed service as it is rendered or completed. You are under no obligation to continue treatment through Waring Wellness and may transfer your care to another facility at any time. Your new service provider will provide you with a new GFE for services.
At Waring Wellness, we believe the therapeutic relationship to be paramount, and we regard your autonomy, right to self-determination, and choice to receive treatment where you will most benefit.
It is important that you understand your right to choose your provider based on your unique needs, the provider's specialization, and the right fit.
NOTE: this estimate does not include healthcare cost associated with:
1) The cost to see another provider that we have recommended (e.g., specialty provider such as your GP, Otolaryngologist or Ears Nose Throat Specialist (ENT), Physical Therapist, Pulmonologist, Allergy/Asthma/Immunologist, Gastroenterologist, another SLP for second opinion or for different assessment or treatment modality, a dietitian, counselor, tutor, coach, etc).
2) The costs of products or theraputic items sold (which are provided as a convenience to you and are optional)
3) The cost of screens or testing (scheduled separately; testing is included with standard SLP/ST session)
4) Late cancelation or no-show fees per our policy
Expected Frequency and Length of Treatment
We recognize that each patient has a unique treatment journey. Factors affecting your length of treatment may include:
- your presenting problem
- history of presenting problem
- stated goals for treatment
- challenges and life circumstance
- availability to schedule and attend sessions
- your support system
- age at problem onset
- presence of commonly co-occurring conditions we see in our patients
- and others
Our standard practice is to create a treatment plan with each patient's input after the initial evaluation. As progress is made or if new problems arise, the treatment plan can be revised/updated.
We cannot determine without an evaluation what the exact frequency and length of treatment may be; However, the cost of services is consistent over time and does not change, as previously outlined.
It will become clearer after you have had an evaluation and a few visits what your overall treatment plan is likely to include. Again, we can update your GFE upon request at anytime.
SLP Use of 97000 CPT Codes:
There may be times when the only code available to describe actual service provided through a Waring Wellness provider falls under the gray area of these 97000 codes.
The American Speech-Language Hearing Association or ASHA has identified the following codes as appropriate and within the scope of practice for SLPs to use. These include: 97129, 97130, and 97533.
Although the 97000 series above have been identified by ASHA as an “approved or appropriate procedural code for use by SLPs” your private insurance carrier may disagree and deny use of this code and any reimbursable OON benefit.
Please be assured that your provider through Waring Wellness will select the most appropriate code to reflect services provided. Your provider will not select a code simply because it may be easier or more favorable to reimburse through your OON benefits. To clarify, your provider will not change a CPT code if you ask because a different, though less accurate code, will be covered through your OON benefits.
If there is an alternative code to the 97000 series listed above, that meets both the description of the service provided, AND is covered by your OON benefits, your provider will certainly use these codes on your invoice.
Location of Services
For your convenience, we conduct both in-person and virtual sessions. The estimate does not change based on your session being in-person or via telehealth. The only exception is for off-site in-person visits at the Dome.
Disclaimers: Federal Requirements and Protections
We ask you to sign this form per the requirements of the No Surprises Act.
We repeat the GFE is NOT a contract, only an indication that you received this estimate and understand the cost of speech pathology services through Waring Wellness/ Kristina Waring MA CCC-SLP.
This GFE shows the costs of items and services that are expected for your health care needs for specific items or services. The estimate is based on information known at the time the estimate was created.
The GFE does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or extraordinary circumstances occur. If this happens, federal law allows you to dispute (appeal) the charges that are invoiced or sent after servcies were rendered.
By law, If you are invoiced for more than $400.00 over the GFE, you have the right to dispute the bill. Again, as we are not submitting charges after the fact this does not apply to Waring Wellness. As a show of transparency, our GFE agrees to this sum as well. All charges will fall within a range that does not exceed 400.00 of the actual GFE based on diagnosis and services provided.
The only time Waring Wellness will provide an invoice is in the event there is a payment issue or technical issue preventing prompt payment at the time of service.
What are my rights under this No Suprises Act?
If you wish to dispute an invoice, you may contact the health care provider to let them know the invoiced charges exceed $400.00 over the GFE. Your process is as follows:
1) You can ask them to update the invoice to match the Good Faith Estimate;
2) Ask to negotiate the charges;
3) Ask if there is financial assistance available.
If you are unable to resolve your dispute 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 outlined above, you must:
1) start the dispute process within 120 calendar days of the date on the original invoice
2) Pay the HHS a $25 fee to use the dispute process
3) Provide your original GFE and invoice showing the charges exceeded the GFE by $400.00
4) If the agency reviewing your dispute agrees with you, you only pay for the price on this GFE
5) If the agency disagrees with you and agrees with the health care provider you pay the higher amount even if it exceeds $400.00 over the cost of the GFE
To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 877-696-6775. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 877-696-6775.
Keep a copy of this Good Faith Estimate in a safe place or store it digitally. You may need it if you are billed a higher amount.
If you want your diagnosis updated on this GFE after your assessment, you must let your clinician know.