Your Right to Receive a Good Faith Estimate

Who receives an estimate?

If you do not have health insurance, or if you choose not to use your insurance for a service, you generally have the right to receive a Good Faith Estimate of expected charges for scheduled health care items and services.

What you can expect

• You may request a Good Faith Estimate before scheduling.
• When care is scheduled far enough in advance, the Practice will provide the estimate within the time required by federal law.
• The estimate will be provided in writing or electronically and will describe reasonably expected charges known at that time.
• The estimate is not a bill or guarantee. Unexpected or additional services may affect the final amount.

If your bill is substantially higher

If a bill from a provider or facility is at least $400 more than the amount listed for that provider or facility on your Good Faith Estimate, you may be eligible for the federal patient-provider dispute resolution process. Keep copies of your estimate and bill.

Learn more at CMS.gov/NoSurprises/Consumers ↗ or call 1-800-985-3059.

Request an estimate

Contact the Practice before scheduling or at any time you would like information about expected self-pay charges.