Good Faith Estimate Policy

ABOUT YOUR RIGHT TO RECEIVE A GOOD FAITH ESTIMATE OF EXPECTED CHARGES

Under the law, as a health care provider, I will give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

This estimate is called a "Good Faith Estimate" and explains how much your Therapy services will cost. Here are a few key things you should know about your Good Faith Estimate:

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • You may ensure that I give you a Good Faith Estimate in writing at least 3 business days before your Therapy services or item. You can also ask me for a Good Faith Estimate prior to scheduling.
  • If you receive a bill that is $400 more than your Good Faith Estimate, you can dispute the bill.
  • It's recommended that you save a copy of your Good Faith Estimate for your records.

For further information, visit www.cms.gov/nosurprises or call 800-985-3059.