Good Faith Estimate

Please review our Good Faith Estimate for services

Good Faith Estimate (GFE) Sweetgrass Homeopathy LLC Services- In compliance with the Federal No Surprises Act (Jan 1, 2022)The purpose of a Good Faith Estimate requirement is to give self pay and uninsured individuals an opportunity to use the information to evaluate their healthcare options, manage care costs and prevent surprise billing. 

Services Included:   
CPT CODE: 99205 / ABC: ACCBH - Initial Appt 120 min
CPT CODE: 99204 / ABC CODE: ACDBF - Follow Up Appt 45 min             
CPT CODE: 99202 / ABC CODE: ACDBE - Acute Care Appt 30 min

Schedule: To schedule services, please contact your provider.
Homeopath providing services:
Bethany Huss RN, CCH (Sweetgrass Homeopathy LLC) NPI: 1740042100 EIN: 88-4148705
Sweetgrass Homeopathy LLC, Mt Pleasant, SC, 29466

This estimated total cost is for Homeopathic services for 1 year. 
Membership services: All clients will have an Initial one time fee for their first appointment. The first month of care will include this Initial one time fee as well as the first monthly membership payment of their choice (Individual/Family). Clients need Follow up Appointments every month for 2 months and then can stretch appointments out to every 6 weeks-3 months. Depending on how care progresses, more or fewer sessions may be needed. All follow up appointments and acute care services given by Sweetgrass Homeopathy are included under this monthly membership fee. *Please be aware of late charges and no show fees listed on Sweetgrass Homeopathy’s website/scheduling and Client expectations document which all clients sign before establishing care. The estimated total costs are valid 1 year from the date of activation/signage of the Membership Agreement document.This Good Faith Estimate does not include adjuncts such as homeopathic medicine recommendations that clients choose to purchase. There will be supplemental items that are recommended for you to purchase but you may choose not to. All items purchased outside of services listed on this document are personal expenses made by the client which they are responsible for.

Contact: If you have questions about this estimate, please contact Bethany Huss CCH with Sweetgrass Homeopathy LLC who can answer questions about your Good Faith Estimate at bethany@sweetgrasshomeopathy.com or 803-807-6203.

Details of the Estimate
The following is a detailed list of expected charges for Homeopathic services scheduled for 1 year of care. The estimated costs are valid for 1 year from the date of start of care/signing membership agreement document. .

Total estimated yearly cost Individual Membership: $700
‍Total estimated yearly cost Family Membership (up to 4 members): $2150 
*Additional Family Members may be added at the Individual Membership rate per person.

Disclaimer
This Good Faith Estimate shows the costs of services that are reasonably expected for the expected services to address your homeopathic care needs. The estimate is based on the information known to [us/me] when [we/I] did the estimate. 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 Sweetgrass Homeopathy at the contact listed below 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. You may discontinue appointments, recommendations and established care at any time.

‍You do not need to take any action at this time such as signing or returning this document. It is recommended that you 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 more than $400 than the estimate provided above.

Bethany Huss RN, CCH Homeopathic Practitioner 
Sweetgrass Homeopathy LLC
www.sweetgrasshomeopathy.com 
‍bethany@sweetgrasshomeopathy.com