Good Faith Estimate

[CONFIRM: Merrissa's review and approval of this notice]

You have the right to receive a "Good Faith Estimate" explaining how much your health care will cost

Under the law, health care providers need to give patients who don't have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.

Who can get an estimate

You can get an estimate if you have no health coverage, or if you have coverage through an employer, your own plan or the federal employee health program and choose not to use it. This rule does not cover people with Medicare, Medicaid, CHIP, TRICARE or VA coverage.

How to get your estimate from us

Tell us you plan to pay for yourself when you book, or call us to ask for an estimate before you book. Our current self pay rates are on our Insurance and Fees page, and each estimate is written for your own care.

Ongoing care

Medication management and therapy usually mean regular visits. One estimate can cover up to 12 months of care and will show how often and how many visits we expect. If your care plan changes, we will send an updated estimate before your next visit.

What the estimate covers

Our estimate lists the visits and services we expect to provide. If you also need care from someone else, such as lab tests, that provider may give you their own estimate. Save a copy or picture of every estimate you receive.

If your bill is higher than your estimate

Please call us first so we can look at it with you. If your bill from us is at least $400 more than your estimate, you can also start the federal patient and provider dispute process within 120 calendar days of receiving your first bill. While a dispute is open, we will not send your bill to collections.