Good Faith Estimate for Health Care Services

Under the No Surprises Act which took effect on January 1, 2022, all self-pay patients are entitled to an estimate of the range of costs that is likely for most patients. A self-pay patient includes all patients who either do not have any insurance coverage OR do not intend to use their insurance coverage for their treatment.

If you qualify for a Good Faith Estimate, you are entitled to receive a notice in writing from the practice at least one (1) business day before your treatment session. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, please contact visit www.cms.gov/nosurprises.